FORM 1023-EZ for PINE REGION LEGAL AID

Field Data
EIN 81-2529165
Case Number EO-2016256-000294
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name PINE REGION LEGAL AID
Organization’s Mailing Address 401 BAYOU DRIVE / STUBBS HALL 222A
City MONROE
State LA
ZIP 71203
Accounting period End 12
Primary contact name SOPHIA DIXON BROWN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SOPHIA DIXON BROWN
OFFICER
401 BAYOU DRIVE
MONROE LA 71209

Officer/Director/Trustee Two

ANGELA CLAXTON
DIRECTOR
805 N BEECH ST / SUITE 3
TALLULAH LA 71282

Officer/Director/Trustee Three

VARHONDA BURRELL
DIRECTOR
700 UNIVERSITY AVE / STUBBS 222B
MONROE LA 71209

Officer/Director/Trustee Four

ELIZABETH WIDHALM
DIRECTOR
316 STEPHENS AVE
NATCHITOCHES LA 71457

Officer/Director/Trustee Five

LAKEISHA J JOHNSON
OFFICER
700 UNIVERSITY AVE / STUBBS 222
MONROE LA 71209

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/5/2016
Organization Incorporation State LA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code I80 - Legal Services
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 Yes
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 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
Signature Title
Signature Date

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