FORM 1023-EZ for FAMILY LIFE AND CHILD DEVELOPMENT CENTER INC

Field Data
EIN 47-1149760
Case Number EO-2018031-000107
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FAMILY LIFE AND CHILD DEVELOPMENT CENTER INC
Organization’s Mailing Address 108 OCONEE STREET
City EATONTON
State GA
ZIP 31024
Accounting period End 12
Primary contact name SHIRLON WILLIS - MATHIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SHIRLON WILLIS - MATHIS
PRESIDENT/CEO
95 SERENA COURT
COVINGTON GA 30016

Officer/Director/Trustee Two

COBIAS WILLIS
CHIEF FINANCIAL OFFICER
35 LAKEBIRCH DRIVE
COVINGTON GA 30016

Officer/Director/Trustee Three

KENMEANNAH DAVIS
SECRETARY
243 PAMPAS DRIVE
POOLER GA 31322

Officer/Director/Trustee Four

NONE NONE
NONE
NONE
NONE GA 30016

Officer/Director/Trustee Five

NONE NONE
GA
NONE
NONE GA 30016

Organization’s website NONE
Organization’s email FLCDC.INC@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/28/14
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: No
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 Yes
One Third Support Public No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement Yes
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name SHIRLON WILLIS - MATHIS
Signature Title PRESIDENT/CEO
Signature Date 1/26/18
EIN 47-1149760
Case Number EO-2016168-000310
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name FAMILY LIFE AND CHILD DEVELOPEMENTCENTER INC
Organization’s Mailing Address 108 OCONEE STREET
City EATONTON
State GA
ZIP 31024
Accounting period End 12
Primary contact name SHIRLON WILLIS - MATHIS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

SHIRLON WILLIS - MATHIS
PRESIDENT/CEO
95 SERENA COURT
COVINGTON GA 30016

Officer/Director/Trustee Two

COBIAS WILLIS
CHEIF FINANCIAL OFFICER
35 LAKEBIRCH DRIVE
COVINGTON GA 30016

Officer/Director/Trustee Three

KENMEANNAH DAVIS
SECRETARY
243 PAMPAS DRIVE
POOLER GA 31322

Officer/Director/Trustee Four

NONE NONE
NONE
NONE
NONE GA 30016

Officer/Director/Trustee Five

NONE NONE
NONE
NONE
NONE GA 30016

Organization’s website NONE
Organization’s email FLCDC.INC@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/25/2014
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 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 Yes
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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