FORM 1023-EZ for CLEMENTINE AKAMBA INC

Field Data
EIN 81-4341767
Case Number EO-2016314-000290
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CLEMENTINE AKAMBA INC
Organization’s Mailing Address 6150 LAURENS XING
City LITHONIA
State GA
ZIP 30038
Accounting period End 12
Primary contact name ROSINE CHARLES
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JEAN GUSTAVE SHOUMOU
ADMINISTRATOR
6150 LAURENS XING
LITHONIA GA 30038

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/7/2016
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code L80 - Housing Support Services -- Other
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 Yes
Conducting Activities Outside of United States Yes
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance Yes
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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