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        <AddressLine1>210 N COLUMBIA ST</AddressLine1>
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        <State>NC</State>
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        <BusinessNameLine1>INTERNATIONAL CONCRETE REPAIR</BusinessNameLine1>
        <BusinessNameLine2>INSTITUTE CAROLINAS CHAPTER</BusinessNameLine2>
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        <AddressLine1>839 FINNBAR DRIVE</AddressLine1>
        <City>CARY</City>
        <State>NC</State>
        <ZIPCode>27519</ZIPCode>
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      <Title>PRESIDENT</Title>
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      <Name>RICHARD ZYCZKIEWICZ CPA MBA</Name>
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      <DatePrepared>2013-11-04</DatePrepared>
      <SelfEmployed>X</SelfEmployed>
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      <MembershipDues>5185</MembershipDues>
      <FundraisingGrossIncome>7955</FundraisingGrossIncome>
      <SpecialEventsDirectExpenses>6066</SpecialEventsDirectExpenses>
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      <PrintingPublicationsPostage>3694</PrintingPublicationsPostage>
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      <CashSavingsAndInvestments>
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      <ProgramServiceAccomplishment>
        <DescriptionProgramServiceAccom>MAINTAIN WEBSITE WITH MEMBERSHIP DIRECTORY, ANNOUNCEMENTS, AND TECHNICAL ARTICLES FOR THE CONCRETE TRADE.</DescriptionProgramServiceAccom>
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      <ProgramServiceAccomplishment>
        <DescriptionProgramServiceAccom>PUBLISH QUARTERLY NEWSLETTER OF CURRENT ACTIVITIES OF THE CHAPTER AND THE BOARD OF DIRECTORS.</DescriptionProgramServiceAccom>
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          <AddressLine1>839 FINNBAR DRIVE</AddressLine1>
          <City>CARY</City>
          <State>NC</State>
          <ZIPCode>27519</ZIPCode>
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