FORM 1023-EZ for DOUBLE 6 DOMINO CLUB INC

Field Data
EIN 47-2316292
Case Number EO-2014353-000292
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name DOUBLE 6 DOMINO CLUB INC
Organization’s Mailing Address 9815 SW 168 TER
City MIAMI
State FL
ZIP 33157
Accounting period End 12
Primary contact name SHARON DESILVA
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

SHARON DESILVA
PRESIDENT, DIRECTOR
9815 SW 168 TER
MIAMI FL 33157

Officer/Director/Trustee Two

SHANE ANDERSON
TREASURER, DIRECTOR
9815 SW 168 TER
MIAMI FL 33157

Officer/Director/Trustee Three

ROGER ALLEYNE
SECRETARY, DIRECTOR
9815 SW 168 TER
MIAMI FL 33157

Organization’s website N/A
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/18/2012
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: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: Yes
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee Yes
Donation of funds Yes
Conducting Activities Outside of United States No
Financial transactions with officers Yes
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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