FORM 1023-EZ for EL ROBLE AZUL FOUNDATION

Field Data
EIN 47-2308198
Case Number EO-2014322-000125
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name EL ROBLE AZUL FOUNDATION
Organization’s Mailing Address 8705 NEW MOUNTAIN WAY
City LAS VEGAS
State NV
ZIP 89123-3663
Accounting period End 12
Primary contact name DALE BOTTOMS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

DALE BOTTOMS
PRESIDENT, SECRETARY, TREASURER
8705 NEW MOUNTAIN WAY
LAS VEGAS NV 89123-3663

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 11/3/2014
Organization Incorporation State NV
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code T99 - Philanthropy, Voluntarism, and Grantmaking Foundations N.E.C.
Organization’s purpose Charitable: Yes
Religious: Yes
Educational: Yes
Scientific: Yes
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 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
Signature Title
Signature Date

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