FORM 1023-EZ for AUDRIANNA MOORE

Field Data
EIN 83-3618727
Case Number EO-2019121-000068
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name AUDRIANNA MOORE
Organization’s Mailing Address 6136 HILLANDALE DR 1106
City LITHONIA
State GA
ZIP 30058
Accounting period End 2
Primary contact name CLARENCE PUROFOY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANGELA LASSITER
C.E.O./C.F.O.
755 LAKESIDE CIR
COVINGTON GA 30016

Officer/Director/Trustee Two

AUDRIANNA MOORE
PRESIDENT/ ASS. C.F.O.
6136 HILLANDALE DR 1106
LITHONIA GA 30058

Officer/Director/Trustee Three

CLARENCE PUROFOY
VICE PRESIDENT/ REPRESENTATIVE
6136 HILLANDALE DR 1106
LITHONIA GA 30058

Officer/Director/Trustee Four

SHARTIA MOORE
SECRETARY
6136 HILLANDALE DR 1106
LITHONIA GA 30058

Officer/Director/Trustee Five

SEDDRICK MOORE
OFFICER
6136 HILLANDALE DR 1106
LITHONIA GA 30058

Organization’s website OPENARMS0219.COM
Organization’s email OPENARMS0219@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/20/19
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code L41 - Homeless, Temporary Shelter For
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 Yes
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance Yes
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 AUDRIANNA MOORE
Signature Title PRESIDENT/ ASS. C.F.O.
Signature Date 4/29/19

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