FORM 1023-EZ for KIDS DOJO

Field Data
EIN 47-3569044
Case Number EO-2015345-000322
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name KIDS DOJO
Organization’s Mailing Address 849 ALMAR SUITE C
City SANTA CRUZ
State CA
ZIP 95060
Accounting period End 12
Primary contact name ROBERT MYLLS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

ROBERT MYLLS
PRESIDENT
254 GETCHELL STREET
SANTA CRUZ CA 95060

Officer/Director/Trustee Two

CAROLYN NOVICOFF
SECRETARY
10002 VOGEL AVE
SCOTTSDALE AZ 85258

Officer/Director/Trustee Three

JERRY ROSE
TREASURER
12572 E PARADISE DR
SCOTTSDALE AZ 85259

Officer/Director/Trustee Four

JAMES LIVINGSTON
DIRECTOR
230 19TH AVENUE
SANTA CRUZ CA 95060

Officer/Director/Trustee Five

DAN BARBATTIN
DIRECTOR
3090 SEDGWICK CIRCLE
LOVELAND CO 80538

Organization’s website KIDSDOJO.ORG
Organization’s email ROB@KIDSDOJO.ORG
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 3/22/2015
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N20 - Recreational and Sporting Camps
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: Yes
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee Yes
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More Yes
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
Signature Title
Signature Date

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