FORM 1023-EZ for GRAMA BLUES HOUSE INC

Field Data
EIN 86-3475938
Case Number EO-2021167-000221
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name GRAMA BLUES HOUSE INC
Organization’s Mailing Address 6353 EL CAJON BLVD STE 124
City SAN DIEGO
State CA
ZIP 92115
Accounting period End 12
Primary contact name MARY BLUE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

MARY BLUE
CEO
6353 EL CAJON BLVD STE 124
SAN DIEGO CA 92115

Officer/Director/Trustee Two

CHAMILLE ADAMS
DIRECTOR
3611 GRANT RD
JOHNSBURG IL 60051

Officer/Director/Trustee Three

AMBER CASEMIRO
DIRECTOR
11655 BRIAR FOREST
HOUSTON TX 77077

Officer/Director/Trustee Four

KANDACE BATTLE
DIRECTOR
1086 REDWOOD AVE APT 9
SAN DIEGO CA 92020

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 5/20/2021
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code F20 - Alcohol, Drug and Substance Abuse, Dependency Prevention and Treatment
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 Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name MARY BLUE
Signature Title CEO
Signature Date 6/14/2021

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