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Detail by Entity Name
Florida Not For Profit Corporafion
LEADERSHIP LEARNING CENTER AT SAINT JOHN BOSCO INC.
Document Number
N09000004284
FEVEIN Number
26-4788070
Date Filed
04130/2009
State
FL
Status
ACTIVE
Lir�I AGII:Irsss
1366 NW 1ST ST.
MIIAMI, FL 33125
Changed: 05/06/2009
1366 NVV1ST ST.
MIAMI, FL 33125
Changed: 05/06/2009
B2-.qist(,r(j,( AjcentNamc&Adores
�i
FITZGERALD, J. PATRICK
110 MERRICK WAY SUITE 3-6
CORAL GABLES, FL 33134
OfficeOM[ector Detail
Name & Address
Title PD
PAGUAGA, JUAN CREV.
1366 NW IST ST,
MIAMI, FL 33125
11mraT121
WORLEY, ELIZABETH SISTER
9401 BISCAYNE BILVE)
MIAMI SHORES, FL 33138
Title SD
11age I ol'2
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Detail by Entity Name
JEANTY, CHANEL REV.
9401 BISCAYNE BLVD
MIAMI SHORES. FL 33138
Aamim Re orfs
Report Year
Filed Date
2014
01/09/2014
2015
01/11/2015
2016
01/25/2016
2(Lcument knaqes
Page 2 of 2
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Completed form should be
Fortir W'9 Request for Taxpayer given to the requesting
Identification Number and Certification department or the department
nillassachusons SubstRute W-9 FormI you are currently doing
Row April 200q,
business with.
Nance I Usl legal name, 0 ,anT nainies k9t first & arcle rhe Isarie of the II wtio�se TIN you enter In Part I -See Specific Instroctlon on page 2�
lusiinoss nalmo, If dUMrjr"qj ffuj", ubQV,e. (See SpeCift Irurnection on paqv, 2�
q . .. ........
P " 1r� n epr" �7 I " � tt" i" )1
N'� u jh Pr fl, b
Check, il"* apii box0 inclividUai/Sole propirJejor 1-1 Corporation ED Partnership ffl Other
Legal Address numbw,, FWOM, andabl, of %Jac, no, iveiriftlance Address it fifteront Groin letial arirlfesg higntivr, alreer, and ilict. or
1%
"allite no
1, 1 , , I r P r i I, I i , ;, r, , I ",
Phone 9 d, "" - 7 F,, # I �' 0 "') (� 1f '� 1
j " ,.r(-`,, )�) �j "W - "� z � � , - j 1� 0
Enter your 111,14 un the : apprapnare box. Far mdrVidualis "ns is yow, sociall
sor,,,w7ty Irsuniber (SSI14) However, for a residont alien, so* proprietor, of
disragairded entity, see this part I Instruction on
page 2 For ottrer enhtIes, 11 is your arnpioyer rdentiftafion nurotier QEiNi tf
you da not have, a rutnber, see Now to got a' N on page 2.
Motes 01 Ihv acr,,,ount es fir rproyp Oran rine name, „mire Ore Owarl cin pag;e 2 for
guiWetofrfs kin who,ie nuri7ber to enter
Vendors;..
Dolan and Bradstreet Universal Numbering System (DUNS)
Certification
state and ZJP code
E"orl address u� tit{ i')Yr , 0,)Pt iln
Sorcial security number
OR
Employer Identification, nurriber
IDUMS
Uroder penalfies of per -jury, I cortify thaa:
1. T no rumbfir shown on this fortr is my corrocr No payer idwitificabon fluii (or I ,urn waiting (or a nurriber to IN Issued to rrie),, and
2, 1 arn rict subject to backup withholding oecause (a) l tarn exernpt frorn backup wilhhoiding or
(b) I have not been notified by the Internal Revenue
Services (IRS) that N anr subjert Ic, backup mthholOrg as as result of a lailure to, report all interest or dividends or (c) the IRS has notified ow that
I arn ria langer subjltira to backup wrthhokflng, and
3, 1 arn ars U & person (inrlud4rq an U.S, resident Wiwi),
4, 11 am c'urrorilly a Commonwealth of Massacht4et9tr's state ernplcyee: (check one�� No— Yes — If yes, the State Ethics
Commission
Certification InstructicI YOU MUST cross out ilem 2 aftove it yrmt Maive been notified by the IRS that ynu are CLVTeo%1 subject to backup Withholding
because you traye failed on your tam rou"i Fai reat estWe Vanw�cbons, rte 2 do!�s
7'
= Authorized Signiature III
A person who is required to file an Information
rolAirn with The IRS inftv qel your, oorrect
taXpayar cronafictition riumber t, I INto toW, for
exainpW, incurne paid to you, real estate
U11VIS000ris, mongage inwiWo you paid,
acquirrition or doo(, of contnhutiom, you rnade to
an IRA
Use horns W-9 only if you are a U.S. person
(including a resident aheil. to give youi correct
TIN to the person ritiquesfing I (iine requester)
fuid , Wri applicable, tiol
1. Cenffy We ON you are giving is correct (or
you are Waifing for a Runibeuto no issued),
2, Cwrify you we rol subject to backup
wet!fthurding:
If you are a foreign person, use the
approprialeParte Vir-it, masts Pub S15,
101thiAdmg of Tax cr Nomewdent Maine and
Foreign CrtrpcAnfws.
What is backup withholding? Persons making
coolant payineints to you must wrirrhold a
designated parceMage, cut rently 28116 ano pay to
condilmns, T his is called bac*up Mhholdirg,'
Payments that may be Subject to backup
w1tivikiing indude inti dividends, bro"r and
baderr excharigs transactions, rents, royM:es,
nonemployee. pay, and ceifaiin payments from
hihing boat opwarom Rrrw,,d ie,,,dale iransixtions
Are not subfict in bri w0holding.
It you give Ihe requester yout corred 11N, make
the proper, cerlifications, an d rettiort all your
taxable Interest arid rjwedwvjs, on your tax rewrn,
payments you recawe Will not 40 silbIect to
bar,*,up withholdlivg, Payments you rermere will
be subject to backup withholding 111:
f.. You (to ata fundsh your Tao to the
rf,q,jueM(rf, ar
2, You do I'M r,Avflfy your TIN when rerpjired
qspe the Pirl III inshurJoilis rin page 2 for
del,afti, Or
S. You do rrot tortly to fie iequitister that you ate
not ot subtat,1 lo backup withholding under 4 above
(for reportabie interest and divideno accounts,
opened after 1983 only),
Certain payees and payrnerits, are exerniot horn
backup wfthholdin% See the earl 11 Instructions
on page 2.
Penalties
Failure to furnish TIN If you fwl I(A luitnish your
rxwern TIN to a requeslei, yriu are subject In a
penalty of S50 for each such fatlure unless yoj
!Mure is due to reasonatile rause ar"I rut to
MINI neglect
Civil penalty for false information with respect
to withholding If you rrOe a faise slaierriorr
Wath no ma5tinable basis (that results fin no backup
'Atthholdmg you are subjec"t to a $500 per"Oty
1 The, 1pRS MIS the feioJeSter th,"It YOU I'L91,1I,hed Criminal penalty for falsifying Informallorri
an a,Tcooect TIN or Miffully faIfOylog cerlificallons or affInnations
may suload you to criminal ineriattins Including
4, The INS WIN, you that you are subject in fines arr6'0r imprisorurriont,
bl(,kLrp withholding rrecause yarn did not
report all your interest and (Jwrri o0y), or Misuse of TINs ll the requeslw discloses or uses
the IRS of 5uch payrrienu, undet certain TINS In violation of Federal taw, the requpstmmay
be subject to rivil -and ofirributl para illirn,
Form MA- W-9 (Rev, April 200911
or's Ceirtificato of Exemption -
—i R.DR0411114
Issued Pursuant to Chapter 212, Florida Stakdes
IWAKIMENJ
Cop
'EVENur
201 it Si 1,5189484C-9 06/02/ 4 06/30/9-019 TI
L)qjirqtjon Date
This certifies that
LEADERSHIP LEARNING CEOTER AT SAINT
JOHN BOSCO INC
1366 NW '1,ST ST
MIAMI FL 33125-5603
,Eye,
is exempt from the payment of F6orlda sales and use tax on real property rented, transient rental property rented, tangible
personal property purchased or rented, or services purchased,
FImportant Informaition for E)ompt Organizations R-14
F R.D04/11
MPARrWNT
OF REVENUF
You must provide all vendors and suppliers with an exemptlon certificate bef.ore making tax-exerript purchases,
See Rule 12A-1.038,, Florida Administrative Code (FA.0 .)'
2, Your Consumer's Certificate or Exem,ption is to be used solely by your organization for your organization's
customary nonprot activities.
& Purchases made by an individual on behalf ofthe organization are taxable, even if the individual will be
reimbursed by the organa zatlon.
4. This exemptton applies only to purchases your organization makes. The sale or lease to others of tangible
personal property, sleeping accommodations, or other real property is taxable. Your organization must register,
and collect and remit sales and use tax on such taxable transactions. Note: Churches are exempt from this
requirement except when they are the lessor of real property (Rule 12A-1,070, FA.C.).
5, It is a criminal offense to fraudulently present this certificate to evade the payment of sales tax. Under no
circumstances should this certificate be used for the personal benefit of any individual. Violators will be liable for
payment of the sales tax plus a penalty of 200% of the tax, and may be subject to conviction of a third-degree
felony. Any vioiation will recuire the revocation of this certificate,
S. If you have questions regarding your oxempbon certificate, please contact the Exemption Unit of Account
Management at 800-352-3671 . From 'the avaflabie options, select "Registration of Taxes," then "Registratiorl
Information," and finally "Exemption Certificates and Nonprofit Entities," The mailing address is PO Box 6480,
Tallahassee, FL 32314-648U