FORM 1023-EZ for HIS HOUSE MISSION INC

Field Data
EIN 83-3703856
Case Number EO-2019077-000650
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HIS HOUSE MISSION INC
Organization’s Mailing Address 3690 AUTUMN VIEW DRIVE NW
City ACWORTH
State GA
ZIP 30101
Accounting period End 1
Primary contact name ROBERT NUNEZ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAVID HUDSON
PRESIDENT
362 OAKWIND POINTE
ACWORTH GA 30101

Officer/Director/Trustee Two

ROBERT NUNEZ
VICE-PRESIDENT
3690 AUTUMN VIEW DRIVE NW
ACWORTH GA 30101

Officer/Director/Trustee Three

DERREK DENARD
TREASURER
6165 OLD STILESBORO ROAD
ACWORTH GA 30101

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/14/19
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: Yes
Religious: Yes
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 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 ROBERT NUNEZ
Signature Title VICE-PRESIDENT
Signature Date 3/15/19

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