FORM 1023-EZ for BUSHIDO KARATE SHOTOKAN USA NON PROFIT

Field Data
EIN 47-5545208
Case Number EO-2016120-000179
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BUSHIDO KARATE SHOTOKAN USA NON PROFIT
Organization’s Mailing Address 5800 MCHINES PLACE SUITE 114
City RALEIGH
State NC
ZIP 27616
Accounting period End 12
Primary contact name JUAN MANUEL RODRIGUEZ
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

JUAN RODRIGUEZ
PRESIDENT
3652 ALLENDALE DR
RALEIGH NC 27604

Officer/Director/Trustee Two

JULIAN ABREU
V. PRESIDENT
5800 MCHAINES PLACE SUITE 114
RALEIGH NC 27616

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/16/2015
Organization Incorporation State NC
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N99 - Recreation, Sports, Leisure, Athletics N.E.C.
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
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 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 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
Signature Title
Signature Date

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