FORM 1023-EZ for PEACH STATE COMMUNITY OUTREACH INC

Field Data
EIN 84-1922347
Case Number EO-2019154-000419
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PEACH STATE COMMUNITY OUTREACH INC
Organization’s Mailing Address 1735 BUFORD HWY STE 215-235
City CUMMING
State GA
ZIP 30041
Accounting period End 12
Primary contact name ALI MIRBAHARI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ALI MIRBAHARI
PRESIDENT, DIRECTOR
1735 BUFORD HWY STE 215-235
CUMMING GA 30041

Officer/Director/Trustee Two

BRIAN GLASPER
SECRETARY, DIRECTOR
PO BOX 4912
ATLANTA GA 30303

Officer/Director/Trustee Three

BYRON AMOS
TREASURER, DIRECTOR
PO BOX 92382
ATLANTA GA 30314

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/21/19
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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 Yes
Donation of funds Yes
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 ALI MIRBAHARI
Signature Title PRESIDENT, DIRECTOR
Signature Date 5/31/19

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