FORM 1023-EZ for KAYA INTERNATIONAL INC

Field Data
EIN 83-1120707
Case Number EO-2018190-000385
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name KAYA INTERNATIONAL INC
Organization’s Mailing Address 192 ARCADO ROAD SW
City LILBURN
State GA
ZIP 30047
Accounting period End 12
Primary contact name ROBERT S BEXLEY
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MOHAMED KASSIM
PRESIDENT
192 ARCADO ROAD SW
LILBURN GA 30047

Officer/Director/Trustee Two

KAREN KRIDER
SECRETARY
192 ARCADO ROAD SW
LILBURN GA 30047

Officer/Director/Trustee Three

AMAL AMED
TREASURER
5470 HUNTINGTON MIST DRIVE
STONE MOUNTAIN GA 30087

Organization’s website WWW.KAYAINTERNATIONAL.ORG
Organization’s email MJKASSIM@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/24/18
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code R24 - Women's Rights
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 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 MOHAMED KASSIM
Signature Title PRESIDENT
Signature Date 7/5/18

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