FORM 1023-EZ for MS MATTIE HOUSE OF REFUGE

Field Data
EIN 84-3008377
Case Number EO-2021083-000614
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MS MATTIE HOUSE OF REFUGE
Organization’s Mailing Address 527 WEST REGENT STREET UNIT 126
City INGLEWOOD
State CA
ZIP 90301
Accounting period End 12
Primary contact name MATTIE L PRUITT
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MATTIE L PRUIT
FOUNDER
527 WEST REGENT STREET UNIT 126
INGLEWOOD CA 90301

Officer/Director/Trustee Two

TALISA PUGH
SECRETARY
637 WEST QUENN STREET APT 2
INGLEWOOD CA 90301

Officer/Director/Trustee Three

ANTANETTE SOWELL
TRUSTEE
1451 NORTH F STREET
SAN BERNARDINO CA 92405

Officer/Director/Trustee Four

MATTIE L PRUITT
DIRECTOR
527 WEST REGENT STREET UNIT 126
INGLEWOOD CA 90301

Officer/Director/Trustee Five

ZAIRE STEPHENS
TREASURE
1451 NORTH F STREET
SAN BERNARDINO CA 92405

Organization’s website
Organization’s email MATTIEPRUITT@ATT.NET
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/10/2017
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A12 - Fund Raising and/or Fund Distribution
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 Yes
Conducting Activities Outside of United States Yes
Financial transactions with officers Yes
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance Yes
One Third Support Public No
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name MATTIE L PRUITT
Signature Title DIRECTOR
Signature Date 11/15/2020

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