FORM 1023-EZ for CONSCIOUS LIVING INSTITUTE

Field Data
EIN 26-3365162
Case Number EO-2014254-000213
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CONSCIOUS LIVING INSTITUTE
Organization’s Mailing Address 32260 - 88TH AVENUE
City LAWTON
State MI
ZIP 49065
Accounting period End 12
Primary contact name PENNY L KELLY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

PENNY KELLY
PRESIDENT
32260 - 88TH AVENUE
LAWTON MI 49065-9331

Officer/Director/Trustee Two

PENELOPE WOOD
SECRETARY-TREASURER
2017 BENJAMIN
KALAMAZOO MI 49008

Officer/Director/Trustee Three

ROBERT LEVY
DIRECTOR
524 N MARSHALL
MARSHALL MI 49068

Officer/Director/Trustee Four

ROBERT METTERT
DIRECTOR
4485 GREAT PLAINS DR
SALEM OR 97305

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/14/2008
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B90 - Educational Services and Schools - Other
Organization’s purpose Charitable: No
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 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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