FORM 1023-EZ for COUNT ME IN INC

Field Data
EIN 80-0252408
Case Number EO-2016078-000218
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name COUNT ME IN INC
Organization’s Mailing Address 4570 FLINT HILL ROAD
City AUSTELL
State GA
ZIP 30106
Accounting period End 12
Primary contact name RICKY MIMS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DENNIS JETER
CFO
5144 SILHOUETTE LANE
MABLETON GA 30126

Officer/Director/Trustee Two

RICKY MIMS
CEO
4570 FLINT HILL ROAD
AUSTELL GA 30106

Officer/Director/Trustee Three

ZENOBIA MIMS
SECRETARY
4570 FLINT HILL ROAD
AUSTELL GA 30106

Organization’s website WWW.COUNTMEIN.ORG
Organization’s email DELUXXINC@AOL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/17/2016
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S80 - Community Service Clubs
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement Yes
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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