FORM 1023-EZ for HISTROTECH INC

Field Data
EIN 84-3773784
Case Number EO-2019338-000352
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HISTROTECH INC
Organization’s Mailing Address 5958 TATE DRIVE
City AUSTELL
State GA
ZIP 30106
Accounting period End 12
Primary contact name DR L NYROBI MOSS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DR LORD AJMER
BOARD CHAIR/PRESIDENT
5958 TATE DRIVE
AUSTELL GA 30106

Officer/Director/Trustee Two

CHERYL HAWKINS
SECRETARY
3051 NORTON CT
SMYRNA GA 30082

Officer/Director/Trustee Three

IVORY TOLBERT
TREASURER
3755 LARAMIE RD
ELLENWOOD GA 30294

Organization’s website
Organization’s email DOCTOR.LORD@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/22/2019
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A23 - Cultural, Ethnic Awareness
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 Yes
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name DR LORD AJMER
Signature Title BOARD CHAIR/PRESIDENT
Signature Date 12/2/2019

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