FORM 1023-EZ for BRILLIANT SMILES ORTHODONTICS KIDZ KLOZET CORP

Field Data
EIN 82-2999499
Case Number EO-2017289-000067
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name BRILLIANT SMILES ORTHODONTICS KIDZ KLOZET CORP
Organization’s Mailing Address 580 MALABAR RD SE
City PALM BAY
State FL
ZIP 32907
Accounting period End 12
Primary contact name LINDA CARLSON
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROMIA GOFF
PRESIDENT
580 MALABAR RD SE
PALM BAY FL 32907

Officer/Director/Trustee Two

LAUREN LOCKHART
VICE-PRESIDENT
4531 N WICKHMAM RD
MELBOURNE FL 32935

Officer/Director/Trustee Three

LINDA CARLSON
SECRETARY
580 MALABAR RD SE
PALM BAY FL 32907

Organization’s website
Organization’s email BSOSMILE@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/18/2017
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code K30 - Food Service, Free Food Distribution Programs
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 Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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