FORM 1023-EZ for DEPORTIVO SANTA ROSA

Field Data
EIN 30-1254707
Case Number EO-2021106-000356
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name DEPORTIVO SANTA ROSA
Organization’s Mailing Address 2524 GARDNER AVE
City SANTA ROSA
State CA
ZIP 95407-6719
Accounting period End 12
Primary contact name DARLENE SANDOVAL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JUAN B HERNANDEZ
PRESIDENT
2524 GARDNER AVE
SANTA ROSA CA 95407-6719

Officer/Director/Trustee Two

REBECA HERNANDEZ ESCAMILLA
TREASURER
2524 GARDNER AVE
SANTA ROSA CA 95407-6719

Officer/Director/Trustee Three

JESUS OSVALDO
SECRETARY
90 ESTRELLA DR
ROHNERT PARK CA 94928-3644

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 10/2/2020
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: Yes
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 JUAN B HERNANDEZ
Signature Title PRESIDENT
Signature Date 4/14/2021

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