FORM 1023-EZ for NORTHERN DORUBIDA INC

Field Data
EIN 38-4089911
Case Number EO-2018332-000055
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name NORTHERN DORUBIDA INC
Organization’s Mailing Address 16027 VENTURA BOULEVARD SUITE 301
City ENCINO
State CA
ZIP 91436
Accounting period End 12
Primary contact name KEITH DAVID
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ALLAN GRAY II
DIRECTOR
2332 NE SMOKEY HILL DRIVE
LEE'S SUMMIT MO 64086

Officer/Director/Trustee Two

DONN INGEMIE
DIRECTOR
PO BOX 1289
SAUGUS MA 1906

Officer/Director/Trustee Three

ADINA JOHNSON
DIRECTOR
185 HALL STREET / 506
BROOKLYN NY 11205

Officer/Director/Trustee Four

KEITH DAVID
DIRECTOR, CEO
16027 VENTURA BLVD / 301
ENCINO CA 91436

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/14/18
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A25 - Arts Education
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 KEITH DAVID
Signature Title DIRECTOR, CEO
Signature Date 11/26/18

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