FORM 1023-EZ for BLUE LIVES MATTER - FLORIDA INC

Field Data
EIN 85-0863232
Case Number EO-2020309-000048
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLUE LIVES MATTER - FLORIDA INC
Organization’s Mailing Address 13266 MENDENHALL PLACE
City JACKSONVILLE
State FL
ZIP 32224
Accounting period End 12
Primary contact name RICHARD DOROUGH
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

RICHARD DOROUGH
PRESIDENT/TREASURER/DIRECTOR
13266 MENDENHALL PLACE
JACKSONVILLE FL 32224

Officer/Director/Trustee Two

GERARD PFISTER
SECRETARY/VICE PRESIDENT/DIRECTOR
12768 CARIBOU COURT
JACKSONVILLE FL 32246

Officer/Director/Trustee Three

NOLAN KEA
DIRECTOR
2169 MESA GRANDE LANE
JACKSONVILLE FL 32224

Officer/Director/Trustee Four

JAMES WILLARD
2ND VICE PRESIDENT/DIRECTOR
4610 SAN JUAN AVENUE
JACKSONVILLE FL 32210

Organization’s website HTTPS://BLUELIVESMATTERFLORIDA.ORG
Organization’s email BLUELIVESMATTER.FL.G@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/23/2020
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code Y12 - Fund Raising and/or Fund Distribution
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 Yes
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 RICHARD DOROUGH
Signature Title PRESIDENT/TREASURER/DIRECTOR
Signature Date 11/2/2020

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