FORM 1023-EZ for ANTONIAS SAFE PLACE

Field Data
EIN 86-3936174
Case Number EO-2021141-000729
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name ANTONIAS SAFE PLACE
Organization’s Mailing Address 1403 LAMONT WAY
City MABLETON
State GA
ZIP 30126
Accounting period End 12
Primary contact name ANTONIA BROWN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ANTONIA BROWN
DIRECTOR
1403 LAMONT WAY
MABLETON CT 30126

Officer/Director/Trustee Two

LATOYA JEFFERSON
TRUSTEE
1171 LAFAYETTE DR SW
MABLETON GA 30126

Officer/Director/Trustee Three

GWEN ALFORD
OFFICER
607 N MAGNOLIA STREET
ALBANY GA 31707

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/18/2021
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T50 - Philanthropy, Charity, Voluntarism Promotion, General
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
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 Yes
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 ANTONIA BROWN
Signature Title DIRECTOR
Signature Date 5/19/2021

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