FORM 1023-EZ for MY REFUGE INC

Field Data
EIN 46-5703394
Case Number EO-2014246-000278
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MY REFUGE INC
Organization’s Mailing Address 822 S JOHNSTONE
City BARTLESVILLE
State OK
ZIP 74003
Accounting period End 12
Primary contact name BRANDI LEE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

BRANDI LEE
PRESIDENT
1437 S SHAWNEE AVE
BARTLESVILLE OK 74003

Officer/Director/Trustee Two

JACK JANSSEN
VICE PRESIDENT
423 COUNTY ROAD 2310
BARNSDALL OK 74002

Officer/Director/Trustee Three

WHITNEY VIRDEN
TREASURER
1500 OAKDALE DRIVE
BARTLESVILLE OK 74006

Officer/Director/Trustee Four

AMY TRUMBLE
SECRETARY
1243 MAY LANE
BARTLESVILLE OK 74006

Officer/Director/Trustee Five

KEN KRISTOF
EXECUTIVE DIRECTOR
502 PARKVIEW DR
BARTLESVILLE OK 74006

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/20/2014
Organization Incorporation State OK
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P01 - Alliance/Advocacy Organizations
Organization’s purpose Charitable: Yes
Religious: Yes
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 No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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