FORM 1023-EZ for INTER MIRIFICA MEDIA INC

Field Data
EIN 82-2196771
Case Number EO-2018218-000275
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name INTER MIRIFICA MEDIA INC
Organization’s Mailing Address 5209 ADAMS ST
City HOLLYWOOD
State FL
ZIP 33021
Accounting period End 12
Primary contact name JUAN J CARCACHE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JUAN CARCACHE
PRESIDENT, DIRECTOR
5209 ADAMS ST
HOLLYWOOD FL 33021

Officer/Director/Trustee Two

MARIAN CARCACHE
SECRETARY, DIRECTOR
718 S GAY ST
AUBURN AL 36830

Officer/Director/Trustee Three

JOHN CARCACHE
TREASURER, DIRECTOR
718 S GAY ST
AUBURN AL 36830

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/1/18
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A33 - Printing, Publishing
Organization’s purpose Charitable: No
Religious: Yes
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 Yes
Conducting Activities Outside of United States Yes
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 JUAN CARCACHE
Signature Title PRESIDENT, DIRECTOR
Signature Date 8/1/18
EIN 82-2196771
Case Number EO-2017205-000241
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name FUNDACION SAN RAFAEL INC
Organization’s Mailing Address 5209 ADAMS ST
City HOLLYWOOD
State FL
ZIP 33021
Accounting period End 12
Primary contact name JACQUELINE MONTANEZ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JUAN CARCACHE
PRESIDENT, DIRECTOR
5209 ADAMS ST
HOLLYWOOD FL 33021

Officer/Director/Trustee Two

JACQUELINE MONTANEZ
SECRETARY, DIRECTOR
7321 PANAMA ST
MIRAMAR FL 33023

Officer/Director/Trustee Three

FERNEY ROJAS
TREASURER, DIRECTOR
20840 SAN SIMEON WAY APT 404
MIAMI FL 33179

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/13/2017
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P20 - Human Service Organizations - Multipurpose
Organization’s purpose Charitable: No
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 Yes
Conducting Activities Outside of United States Yes
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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