FORM 1023-EZ for MAROSE CHILDREN VILLAGE INC

Field Data
EIN 86-2712406
Case Number EO-2021100-001332
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name MAROSE CHILDREN VILLAGE INC
Organization’s Mailing Address 1500 SOMERSET VALE COURT
City LAWRENCEVILLE
State GA
ZIP 30044
Accounting period End 12
Primary contact name ROSE A TABI
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

SHABNAM BHAYANI
PRESIDENT
2072 SUGARSTONE DRIVE
LAWRENCEVILLE GA 30043

Officer/Director/Trustee Two

SHARON OCONNOR
SECRETARY
4423 WELLS SPRINGS COURT
BUFORD GA 30519

Officer/Director/Trustee Three

LAURA TORRES
TREASURY
5139 JIMMY CARTER BLVD STE 206
NORCROSS GA 30093

Officer/Director/Trustee Four

TRISTREM MCLENDON
SUB COMMITTEE MEMBER
4868 WILKIE WAY NW
ACWORTH GA 30102

Officer/Director/Trustee Five

ROSE TABI
CEO
1500 SOMERSET VALE COURT
LAWRENCEVILLE GA 30044

Organization’s website
Organization’s email RAR615@YAHOO.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/18/2021
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code L41 - Homeless, Temporary Shelter For
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
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 Yes
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More Yes
Gaming Activity No
Disaster relief assistance No
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 ROSE TABI
Signature Title CEO
Signature Date 3/31/2021

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