FORM 1023-EZ for MOTHER CLUCKERS MICROSANCTUARY INC

Field Data
EIN 87-2644760
Case Number EO-2021265-000295
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MOTHER CLUCKERS MICROSANCTUARY INC
Organization’s Mailing Address 1737 NEWFOUND ROAD
City LEICESTER
State NC
ZIP 28748
Accounting period End 12
Primary contact name ANISSA METHENY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANISSA METHENY
PRESIDENT AND DIRECTOR
1737 NEWFOUND ROAD
LEICESTER NC 28748

Officer/Director/Trustee Two

SUSAN BURVAL
TREASURER AND DIRECTOR
1393 BEDFORD ROAD
CHARLESTON WV 25314

Officer/Director/Trustee Three

MICHAEL HUMPHRIES
SECRETARY AND DIRECTOR
1737 NEWFOUND ROAD
LEICESTER NC 28748

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/12/2021
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code D20 - Animal Protection and Welfare
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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 ANISSA METHENY
Signature Title PRESIDENT AND DIRECTOR
Signature Date 9/20/2021

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