FORM 1023-EZ for C LLOYD CLAY MEMORIAL INC

Field Data
EIN 47-1490472
Case Number EO-2014226-000130
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name C LLOYD CLAY MEMORIAL INC
Organization’s Mailing Address 57 VILLAGE WAY
City CLAYTON
State GA
ZIP 30525
Accounting period End 12
Primary contact name CHRISTOPHER CLAY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

CHRISTOPHER CLAY
CEO
57 VILLAGE WAY
CLAYTON GA 30525

Officer/Director/Trustee Two

AUSTIN PERRY
ATTORNEY
PO DRAWER 1408
TOCCOA GA 30577

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/19/2014
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O12 - Fund Raising and/or Fund Distribution
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 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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