FORM 1023-EZ for BURNING BLUE ROSE

Field Data
EIN 81-0782132
Case Number EO-2016106-000197
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BURNING BLUE ROSE
Organization’s Mailing Address 3478 HACKAMORE DRIVE
City HAYWARD
State CA
ZIP 94541
Accounting period End 12
Primary contact name LOIS SNELL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

REGINA WARD
PRESIDENT
3478 HACKAMORE DRIVE
HAYWARD CA 94541

Officer/Director/Trustee Two

LOIS SNELL
SECRETARY
3478 HACKAMORE DRIVE
HAYWARD CA 94541

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/9/2015
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code L22 - Senior Citizens' Housing/Retirement Communities
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 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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