| Entity Name: | THE PROVENANCE FOUNDATION FOR SELF ACTUALIZATION, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 21 Dec 2015 (9 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 17 Oct 2019 (5 years ago) |
| Document Number: | N15000012075 |
| FEI/EIN Number | 81-0897024 |
| Address: | 11705 BOYETTE ROAD, SUITE #515, RIVERVIEW, FL, 33569, US |
| Mail Address: | 11705 BOYETTE ROAD, SUITE #515, RIVERVIEW, FL, 33569, US |
| ZIP code: | 33569 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| Name | Role | Address |
|---|---|---|
| LEMONS WILLIE JR | Agent | 11514 BUTTON BAY PLACE, GIBSONTON, FL, 33534 |
| Name | Role | Address |
|---|---|---|
| LEMONS WILLIE JR. | President | 11514 BUTTON BAY PLACE, GIBSONTON, FL, 33534 |
| Name | Role | Address |
|---|---|---|
| BOWDEN CYNTHIA | Director | 11514 BUTTON BAY PLACE, GIBSONTON, FL, 33534 |
| MCMICHAEL SONIA | Director | 229 BAINBRIDGE, EVANS, GA, 30809 |
| TRIGG GREGORY JJR. | Director | 7114 SILVERMILL DR, TAMPA, FL, 33635 |
| WILSON ELMER | Director | 5204 BAYWATER DRIVE, TAMPA, FL, 33615 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2019-10-17 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2019-10-17 | LEMONS, WILLIE, JR | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-06-13 | 11705 BOYETTE ROAD, SUITE #515, RIVERVIEW, FL 33569 | No data |
| CHANGE OF MAILING ADDRESS | 2016-06-13 | 11705 BOYETTE ROAD, SUITE #515, RIVERVIEW, FL 33569 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-07-27 |
| ANNUAL REPORT | 2023-01-08 |
| ANNUAL REPORT | 2022-07-17 |
| ANNUAL REPORT | 2021-03-14 |
| ANNUAL REPORT | 2020-03-16 |
| REINSTATEMENT | 2019-10-17 |
| ANNUAL REPORT | 2018-09-02 |
| ANNUAL REPORT | 2017-04-23 |
| ANNUAL REPORT | 2016-01-27 |
| Domestic Non-Profit | 2015-12-21 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
