FORM 1023-EZ for BLACK ICE JUDO

Field Data
EIN 85-1030125
Case Number EO-2020143-000325
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BLACK ICE JUDO
Organization’s Mailing Address 2104 SOMERSET PLACE
City ATLANTA
State GA
ZIP 30316
Accounting period End 12
Primary contact name JOSHUA WHITE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JOSHUA WHITE
CEO
2104 SOMERSET PLACE SE
ATLANTA GA 30316

Officer/Director/Trustee Two

DAVID KILSEY
INCORPORATOR
480 JOHN WESLEY DOBBS AVE NE
ATLANTA GA 30312-5328

Officer/Director/Trustee Three

MALIK S LEE
INCORPORATOR
5500 SPRING STONE COURT
DALLAS GA 30157

Organization’s website WWW.BLACKICEFITNESS.COM
Organization’s email BLACKICEFITNESS@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 4/21/2020
Organization Incorporation State GA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code N99 - Recreation, Sports, Leisure, Athletics N.E.C.
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 JOSHUA WHITE
Signature Title CEO
Signature Date 5/20/2020

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