FORM 1023-EZ for MIND BUBBLE INCORPORATED

Field Data
EIN 81-4563768
Case Number EO-2016348-000335
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name MIND BUBBLE INCORPORATED
Organization’s Mailing Address 226 KNOB HILLS CIRCLE
City DECATUR
State GA
ZIP 30030-1664
Accounting period End 12
Primary contact name DANIEL PETERSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DANIEL PETERSON
EXECUTIVE DIRECTOR
226 KNOB HILLS CIRCLE
DECATUR GA 30030-1664

Officer/Director/Trustee Two

ERIC CANOSA
BOARD MEMBER
704 SUMMIT POINTE WAY NORTHEAST
ATLANTA GA 30329-4035

Officer/Director/Trustee Three

EMILY PETERSON
BOARD MEMBER
759 TWIN OAKS DRIVE APT 3
DECATUR GA 30030-4023

Officer/Director/Trustee Four

TONY CADE
BOARD MEMBER
4658 WEYBURN LANE
STONE MOUNTAIN GA 30083-5548

Officer/Director/Trustee Five

AMY DANGELO
BOARD MEMBER
3821 OAKCLIFF INDUSTRIAL COURT
ATLANTA GA 30340-3406

Organization’s website MINDBUBBLE.ORG
Organization’s email MIND.BUBBLE.ATL@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/9/2016
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B90 - Educational Services and Schools - Other
Organization’s purpose Charitable: No
Religious: No
Educational: Yes
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 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
Signature Title
Signature Date

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