FORM 1023-EZ for A HOUSE OF REFUGE LIFE CENTER INC

Field Data
EIN 82-1814568
Case Number EO-2019259-000208
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name A HOUSE OF REFUGE LIFE CENTER INC
Organization’s Mailing Address 934 A7 SPRING FOREST RD
City GREENVILLE
State NC
ZIP 27834
Accounting period End 6
Primary contact name GEORGIA SMITH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

GEORGIA SMITH
PRESIDENT
3013 MS PAUL LANE
GREENVILLE NC 27834

Officer/Director/Trustee Two

GLADYS PRIDGEN
VICE PRESIDENT
102 WALDEN WOODS DR
LAGRANGE NC 28551

Officer/Director/Trustee Three

ASHLEY JONES
SECRETARY
5294 HIGHWAY 903 S
SNOWHILL NC 28580

Officer/Director/Trustee Four

GWEN ANDERSON
DIRECTOR
41 PASHA DR
HOOKERTON NC 28538

Organization’s website
Organization’s email SMITHMASONRY252@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/17/17
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
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 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 GEORGIA SMITH
Signature Title PRESIDENT
Signature Date 9/14/19

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