FORM 1023-EZ for DOMINO ENSEMBLE

Field Data
EIN 83-2953394
Case Number EO-2019051-000345
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name DOMINO ENSEMBLE
Organization’s Mailing Address 5605 LAKE SHORE DR
City KNOXVILLE
State TN
ZIP 37920
Accounting period End 12
Primary contact name JORGE VARIEGO
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JORGE VARIEGO
DIRECTOR
5605 LAKE SHORE DR
KNOXVILLE TN 37920

Officer/Director/Trustee Two

HILLARY HERNDON
TREASURER
1741 VOLUNTEER BLVD
KNOXVILLE TN 37996

Officer/Director/Trustee Three

ANA ROSA SISMONDI
SECRETARY
1750 JAMES AVE
MIAMI BEACH FL 33139

Organization’s website WWW.DOMINOENSEMBLE.COM
Organization’s email INFO@DOMINOENSEMBLE.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/27/18
Organization Incorporation State TN
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code A6C - Music Groups, Bands, Ensembles
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 JORGE VARIEGO
Signature Title DIRECTOR
Signature Date 2/15/19

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