Form Ct-12f - Tax Return For Foreign Charities - 2010

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Form
Charitable Activities Section
For Accounting Periods Beginning in:
CT-12F
Oregon Department of Justice
2010
1515 SW 5th Avenue, Suite 410
VOICE (971) 673-1880
Portland, OR 97201-5451
TTY
(800) 735-2900
For Foreign Charities
E-Mail: charitable.activities@doj.state.or.us
FAX
(971) 673-1882
Web site:
Section I.
General Information
1.
Cross Through Incorrect Items and Correct Here:
(See instructions for change of name or accounting period.)
Registration #:
Organization Name:
Address:
City, State, Zip:
Phone:
Fax:
Amended
Email:
Report?
Period Beginning:
/
/
Period Ending:
/
/
2.
Did a certified public accountant audit your financial records? - If yes, attach a copy of the auditor’s report, financial statements,
Yes
No
accompanying notes, schedules, or other documents supplementing the report or financial statements.
3.
Is the organization a party to a contract involving person-to-person, advertising, vending machine or telephone fund-raising in
Yes
No
Oregon?
If yes, write the name of the fund-raising firm(s) who conducts the campaign(s):___________________________________
4.
Has the organization or any of its officers, directors, trustees, or key employees ever signed a voluntary agreement with any
government agency, such as a state attorney general, or secretary of state, or local district attorney, or been a party to legal
Yes
No
action in any court regarding charitable solicitation, administration, management, or fiduciary practices? If yes, attach
explanation of each such agreement or action. See instructions
5.
During this reporting period, did the organization amend its articles of incorporation, bylaws, or trust documents, OR did the
organization receive a determination letter from the Internal Revenue Service indicating a new or amended tax-exempt status?
Yes
No
If yes, attach a copy of the amended document or letter.
6.
Is the organization ceasing operations in Oregon and is this the final report? (If yes, see instructions on how to close your
Yes
No
registration.)
7.
Provide contact information for the person responsible for retaining the organization’s records.
Name
Position
Phone
Mailing Address & Email Address
8.
List of Officers, Directors, Trustees and Key Employees – List each person who held one of these positions at any time during the year even if they did
not receive compensation. Attach additional sheets if necessary. If an attached IRS form includes substantially the same compensation information,
the phrase “See IRS Form” may be entered in lieu of completing that section.
(A) Name, mailing address, daytime phone number
(B) Title &
(C)
and email address
average weekly
Compensation
hours devoted to
(enter $0 if
position
position unpaid)
Name:
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Address:
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Phone:
(_ _ _) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Email:
Name:
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Address:
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Phone:
(_ _ _) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Email:
Name:
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Address:
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Phone:
(_ _ _) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Email:
Form Continued on Reverse Side

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