FORM 1023-EZ for CHURCH OF BLUES INC

Field Data
EIN 87-1208808
Case Number EO-2021172-000537
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name CHURCH OF BLUES INC
Organization’s Mailing Address 705 CARLIN RD
City SATSUMA
State FL
ZIP 32189
Accounting period End 12
Primary contact name DAVID WATSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

DAVID WATSON
PRESIDENT
705 CARLIN ROAD
SATSUMA FL 32189

Officer/Director/Trustee Two

SUMMER ZIFCO
SECRETARY
6001 RYDER AVE
CHARLOTTE NC 28226

Officer/Director/Trustee Three

JEFFREY KNIGHT
VICE PRESIDENT
701 CARLIN RD
SATSUMA FL 32189

Organization’s website
Organization’s email CHURCHOFBLUES@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/15/2021
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code X99 - Religion Related, Spiritual Development N.E.C.
Organization’s purpose Charitable: No
Religious: Yes
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 DAVID WATSON
Signature Title PRESIDENT
Signature Date 6/18/2021

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