FORM 1023-EZ for BLAQOUT INC
| Field | Data |
|---|---|
| EIN | 82-1144166 |
| Case Number | EO-2018004-000180 |
| Form 1023-EZ version | 12018 |
| Eligibility Worksheet | 1 |
| Organization Name | BLAQOUT INC |
| Organization’s Mailing Address | 517 CAMPBELL |
| City | KANSAS CITY |
| State | MO |
| ZIP | 64106 |
| Accounting period End | 12 |
| Primary contact name | ADRIENNE HAYNES |
| Primary contact phone | [Hidden] |
| Primary contact phone extension | [Hidden] |
| Primary contact fax | [Hidden] |
| User fee submitted | $275.00 |
Officer/Director/Trustee One
DARYL GILMORE
PRESIDENT
517 CAMPBELL
KANSAS CITY MO 64106
Officer/Director/Trustee Two
TUSDAY DUDLEY
TREASURER SECRETARY
2154 SW RAMBLING VINE RD
LEES SUMMIT MO 64082
Officer/Director/Trustee Three
LAWRENCE CRAWFORD
VICE PRESIDENT
5103 FAIRWAY ST
KANSAS CITY MO 64129
Officer/Director/Trustee Four
JACQUES SIMMONS
DIRECTOR
6435 COLLEGE AVE
KANSAS CITY MO 64130
Officer/Director/Trustee Five
KRISTIN CHOW
DIRECTOR
4330 CAMPBELL ST
KANSAS CITY MO 64110
| Organization’s website | WWW.BLAQOUT.ORG |
|---|---|
| Organization’s email | HELLO@BLAQOUT.ORG |
| Organization Incorporated | Yes |
| Organization trust | No |
| Necessary Organizing Documents | Yes |
| Organization Incorporation Date | 4/11/17 |
| Organization Incorporation State | MO |
| Contains Limitation | Yes |
| Does not expressly empower | Yes |
| Contains dissolution | Yes |
| National Taxonomy of Exempt Entities (NTEE) code | E70 - Public Health Program (Includes General Health and Wellness Promotion Services) |
| Organization’s purpose | Charitable: Yes Religious: No Educational: Yes 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 | DARYL GILMORE |
| Signature Title | PRESIDENT |
| Signature Date | 1/2/18 |
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