FORM 1023-EZ for SHACKLE FREE COMMUNITY OUTREACH AGENCY INC

Field Data
EIN 83-4541531
Case Number EO-2019143-000218
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name SHACKLE FREE COMMUNITY OUTREACH AGENCY INC
Organization’s Mailing Address 705 KIWI STONE CIRCLE
City JACKSONVILLE
State NC
ZIP 28546
Accounting period End 12
Primary contact name CHIQUITTA W LESENE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAN SMITH JR
CHAIRPERSON
331 PIKE CREEK ROAD
BURGAW NC 28425

Officer/Director/Trustee Two

RACHEL SCOTT
TREASURER
1008 PONDEROSA PLACE
JACKSONVILLE NC 28546

Officer/Director/Trustee Three

PHILLIP FARLAND
VICE-CHAIRPERSON
1016 MEGSON COURT
RALEIGH NC 27614

Officer/Director/Trustee Four

ANNITONETTE WASHINGTON
SECRETARY
249 W BEST ROAD
KENANSVILLE NC 28349

Officer/Director/Trustee Five

IDA MCGEE
BOARD MEMBER
159 GLENDALE VILLAGE LANE
WALLACE NC 28466

Organization’s website
Organization’s email CWLESENE@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/14/19
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
Organization’s purpose Charitable: Yes
Religious: Yes
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 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 RACHEL SCOTT
Signature Title TREASURER
Signature Date 5/21/19

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