FORM 1023-EZ for A PLACE OF REFUGE

Field Data
EIN 82-5523856
Case Number EO-2018136-000363
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name A PLACE OF REFUGE
Organization’s Mailing Address 104 HANNAH CIRCLE
City CALERA
State AL
ZIP 35040
Accounting period End 12
Primary contact name LA TANYA JACKSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JEREMY JACKSON
PASTOR
PO BOX 19562
BIRMINGHAM AL 35219

Officer/Director/Trustee Two

LA TANYA JACKSON
MINISTER
PO BOX 19562
BIRMINGHAM AL 35219

Officer/Director/Trustee Three

BRENDA TERRY
MINISTER
104 HANNAH CIRCLE
CALERA AL 35040

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/11/18
Organization Incorporation State AL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X20 - Christian
Organization’s purpose Charitable: No
Religious: Yes
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 No
Donation of funds Yes
Conducting Activities Outside of United States Yes
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance Yes
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 LA TANYA JACKSON
Signature Title MINISTER
Signature Date 5/11/18

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