FORM 1023-EZ for BLACK AND BROWN THEATRE

Field Data
EIN 81-4521583
Case Number EO-2017130-000434
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BLACK AND BROWN THEATRE
Organization’s Mailing Address 11471 MITCHELL ST APT 2
City HAMTRAMCK
State MI
ZIP 48212
Accounting period End 12
Primary contact name EMILIO RODRIGUEZ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

EMILIO RODRIGUEZ
PRESIDENT
11471 MITCHELL ST APT 2
HAMTRAMCK MI 48212

Officer/Director/Trustee Two

MONA LUCIUS-BURNS
SECRETARY
2452 CROOKS ROAD
TROY MI 48084

Officer/Director/Trustee Three

KAREN BREHMER
TREASURER
4214 THREE OAKS DRIVE
TROY MI 48908

Officer/Director/Trustee Four

ARRIELLE MOCK
VICE PRESIDENT
11471 MITCHELL ST APT 2
HAMTRAMCK MI 48212

Officer/Director/Trustee Five

LEXI MABRY
BOARD MEMBER
3933 TRUMBULL
DETROIT MI 48308

Organization’s website WWW.BLACKANDBROWNTHEATRE.ORG
Organization’s email INFO@BLACKANDBROWNTHEATRE.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/26/2017
Organization Incorporation State MI
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A65 - Theater
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: Yes
Literary: Yes
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 Yes
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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