FORM 1023-EZ for FUSDAM INC

Field Data
EIN 83-4081804
Case Number EO-2019129-000271
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name FUSDAM INC
Organization’s Mailing Address 210 S VILLAGE DRUNIT 201
City ST PETERSBURG
State FL
ZIP 33716
Accounting period End 12
Primary contact name JULIO BALLESTAS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JULIO BALLESTAS
PRESIDENT
210 S VILLAGE DR UNIT 201
ST PETERSBURG FL 33716

Officer/Director/Trustee Two

JUIDTH BALLESTAS
SECRETARY
3165 SPOONBILL CT
CLEARWATER FL 33702

Officer/Director/Trustee Three

BALLESTAS JOSEFINA
TREASURER
210 S VILLAGE DR UNIT 201
ST PETERSBURG FL 33716

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/26/18
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code P75 - Senior Continuing Care Communities
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 JULIO BALLESTAS
Signature Title PRESIDENT
Signature Date 5/7/19

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