FORM 1023-EZ for BLUE AMBER INC

Field Data
EIN 83-3610084
Case Number EO-2019053-000099
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLUE AMBER INC
Organization’s Mailing Address 3724 SALEM SPRINGS COURT
City LITHONIA
State GA
ZIP 30038
Accounting period End 12
Primary contact name DR KETCHIA WOODS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

CATHY ROSEMOND
SECRETARY
3470 CROWN POINT PLACE
DECATUR GA 30032

Officer/Director/Trustee Two

CYNTHIA CRAWFORD
TREASURER
1565 LINDA WAY SW
ATLANTA GA 30310

Officer/Director/Trustee Three

KETCHIA WOODS
CEO
3724 SALEM SPRINGS COURT
LITHONIA GA 30038

Organization’s website
Organization’s email KETCHIASMITH@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/30/18
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P30 - Children's, Youth Services
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 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 KETCHIA WOODS
Signature Title CEO
Signature Date 2/20/19

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