FORM 1023-EZ for MADISONS AVENUE ON 30A INC

Field Data
EIN 83-3592480
Case Number EO-2021100-000996
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MADISONS AVENUE ON 30A INC
Organization’s Mailing Address 33 CUPRESSUS LN
City FORT WALTON BEACH
State FL
ZIP 32548
Accounting period End 12
Primary contact name BRIAN ELBERT CPA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JENNIFER COURTNEY
PSD
33 CUPRESSUS LN
FORT WALTON BEACH FL 32548

Officer/Director/Trustee Two

RAYMOND COURTNEY
TD
33 CUPRESSUS LN
FORT WALTON BEACH FL 32548

Officer/Director/Trustee Three

MIA HONGYEE
D
33 CUPRESSUS LN
FORT WALTON BEACH FL 32548

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/8/2019
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code G84 - Autism
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 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 JENNIFER COURTNEY
Signature Title PSD
Signature Date 3/30/2021

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