FORM 1023-EZ for GUARDIAN ANGEL SOCIAL SERVICE AGENCY INC

Field Data
EIN 84-2462559
Case Number EO-2020181-000738
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name GUARDIAN ANGEL SOCIAL SERVICE AGENCY INC
Organization’s Mailing Address P O BOX 2485
City DULUTH
State GA
ZIP 30096
Accounting period End 12
Primary contact name MERCEDES B PEGUERO
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MERCEDES B PEGUERO
CHAIRPERSON/PRESIDENT
1723 RIDGE BROOK TRAIL
DULUTH GA 30096

Officer/Director/Trustee Two

DR SABRINA MCKENZIE
VICE CHAIRPERSON/VP
1887 CHEDWORTH COURT
STONE MOUNTAIN GA 30087

Officer/Director/Trustee Three

LEVI MACSHEEN
2ND VICE CHAIRPERSON/VP
1207 PARKSIDE CLUB DRIVE
LAWRENCEVILLE GA 30044

Officer/Director/Trustee Four

JOHN D BARFIELD
MEMBER AT LARGE
1902 WEST 23RD STREET
WEST PALM BEACH FL 33404

Officer/Director/Trustee Five

DERRICK THOMAS
MEMBER AT LARGE
318 SALEM GLEN WAY
CONYERS GA 30013

Organization’s website
Organization’s email INFO.GASSA2000@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/5/2019
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A70 - Humanities Organizations
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 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 Yes
Correctness Declaration Yes
Signature Name MERCEDES B PEGUERO
Signature Title CHAIRPERSON/PRESIDENT
Signature Date 6/27/2020

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