FORM 1023-EZ for MAES HOUSE OF REFUGE INC

Field Data
EIN 87-1490706
Case Number EO-2021187-000442
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MAES HOUSE OF REFUGE INC
Organization’s Mailing Address 9394 SLEEPY HOLLOW LANE
City JONESBORO
State GA
ZIP 30238
Accounting period End 12
Primary contact name KAREN BLACK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

KAREN BLACK
PRESIDENT
9394 SLEEPY HOLLOW LANE
JONESBORO GA 30238

Officer/Director/Trustee Two

KENNETH MUHAMMAD
SECRETARY
1204 DARREN DRIVE
PORTSMOUTH VA 23701

Officer/Director/Trustee Three

KAASHIF AMEER
TREASURE
12078 OLMSTEAD DRIVE
FAYETTEVILLE GA 30215

Organization’s website
Organization’s email BLACKKM42@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/2/2021
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P33 - Child Day Care
Organization’s purpose Charitable: Yes
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 KAREN BLACK
Signature Title PRESIDENT
Signature Date 7/2/2021

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