FORM 1023-EZ for CLUB AGAPE

Field Data
EIN 26-3958442
Case Number EO-2015205-000301
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name CLUB AGAPE
Organization’s Mailing Address 5205 MAIN ST
City ASHTABULA
State OH
ZIP 44004
Accounting period End 12
Primary contact name LOIS MILLER-MARTONE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DOMINIC MARTONE
CHAIRPERSON
1809 W 16TH
ASHTABULA OH 44004

Officer/Director/Trustee Two

GEORGE RHEIN
VICE CHAIRPERSON
5035 N RIDGE RD E
ASHTABULA OH 44004

Officer/Director/Trustee Three

WANDA GAMBLE
SECRETARY
PO BOX 1343
ASHTABULA OH 44005

Officer/Director/Trustee Four

LOIS MILLER-MARTONE
TREASURER
1809 W 16TH
ASHTABULA OH 44004

Officer/Director/Trustee Five

AARON CARR
MEMBER
1109 ELK DR
ASHTABULA OH 44004

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 2/10/2009
Organization Incorporation State OH
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F20 - Alcohol, Drug and Substance Abuse, Dependency Prevention and Treatment
Organization’s purpose Charitable: No
Religious: No
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
Signature Title
Signature Date

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