FORM 1023-EZ for MY MENTOR ME

Field Data
EIN 82-2390952
Case Number EO-2017228-000296
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MY MENTOR ME
Organization’s Mailing Address 2700 AMBASSADOR CAFFERY PKWY APT131
City LAFAYETTE
State LA
ZIP 70506
Accounting period End 12
Primary contact name SONYA ANTOINE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SONYA ANTOINE
DIRECTOR
2700 AMBASSADOR CAFFERY PKWY APT131
LAFAYETTE LA 70506

Officer/Director/Trustee Two

LATANYA HOSKINS
DIRECTOR
303 HAMNER AVENUE
LAFAYETTE LA 70501

Officer/Director/Trustee Three

MYLESHA JOHNSON
DIRECTOR
210 DUFOUR ST EXT
MOREAUVILLE LA 71355

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/4/2017
Organization Incorporation State LA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F60 - Counseling, Support Groups
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 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 No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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