FORM 1023-EZ for FANTASY REFUGE

Field Data
EIN 83-3908930
Case Number EO-2019080-000410
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FANTASY REFUGE
Organization’s Mailing Address 131 COLE MANOR DR
City ATHENS
State GA
ZIP 30606
Accounting period End 12
Primary contact name TYA MARTIN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TYA MARTIN
CEO
131 COLE MANOR DR
ATHENS GA 30606

Officer/Director/Trustee Two

RONALD MARTIN
PRESIDENT
400 HAWTHORNE AVE
ATHENS GA 30606

Officer/Director/Trustee Three

TIJUANA MARTIN
VICE PRESIDENT
400 HAWTHORNE AVE
ATHENS GA 30606

Officer/Director/Trustee Four

GEORGE MOON
SECRETARY
122 AUSTIN CT
ATHENS GA 30606

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/18/19
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code L40 - Low-Cost Temporary Housing
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 Yes
Donation of funds Yes
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 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 TYA MARTIN
Signature Title CEO
Signature Date 3/19/19

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