FORM 1023-EZ for MY BLENDED FAMILY ROCKS

Field Data
EIN 82-1436484
Case Number EO-2017128-000408
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MY BLENDED FAMILY ROCKS
Organization’s Mailing Address 517 COVENTRY WAY
City MCDONOUGH
State GA
ZIP 30252-3628
Accounting period End 12
Primary contact name DEMETRA MORGAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CHARMAINE BROOME
PRESIDENT
517 COVENTRY WAY
MCDONOUGH GA 30252-3628

Officer/Director/Trustee Two

JEREMY LUCKEY
TREASURER
8384 ROSWELL ROAD APT N
ATLANTA GA 30350-6417

Officer/Director/Trustee Three

RAQUEL BONE
SECRETARY
647 CONISBURGH COURT
STONE MOUNTAIN GA 30087-4965

Officer/Director/Trustee Four

CLAUDE BROOME II
DIRECTOR
517 COVENTRY WAY
MCDONOUGH GA 30252-3628

Officer/Director/Trustee Five

SHARON TURNER
DIRECTOR
8301 MASTERS WAY
ALPHARETTA GA 30005-8837

Organization’s website WWW.BLENDEDFAMILIESROCK.COM
Organization’s email MYBLENDEDFAMILYROCKS@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/3/2017
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P40 - Family Services
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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