Form Ct-12f - Tax Return For Foreign Charities - 2010 Page 2

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Section II.

Fee Calculation

Total Oregon Revenue .............................................................................................................

(If Oregon revenue is unknown or cannot be reasonably estimated, write the total revenue from Line 12 (current year) on

Form 990; Line 9 on Form 990-EZ; or Part I, Line 12a on Form 990-PF.) (If estimated, or if organization claims no

Oregon revenue, attach explanation.)

10.

Revenue Fee ...........................................................................................................................................................................

10.

(See chart below. Minimum fee is $10, even if total revenue is a negative amount.)

Amount on Line 9

Revenue Fee

$24,999

$10

$25,000

$49,999

$25

$50,000

$99,999

$45

$100,000

$249,999

$75

$250,000

$499,999

$100

$500,000

$749,999

$135

$750,000

$999,999

$170

$1,000,000

$200

11.

Oregon Net Assets or Fund Balances at the End of the

Reporting Period...........................................................................

11.

(If the Oregon amount is unknown, write the total net assets or fund balances from

Line 22 (end of year) on Form 990; Line 21 on Form 990-EZ; or Part III, Line 6 on

Form 990-PF.)

12.

Oregon Net Fixed Assets Used to Conduct Charitable Activities .

12.

(If the Oregon amount is unknown, write $0.)

13.

Amount Subject to Net Assets or Fund Balances Fee...............................................................

13.

(Line 11 minus line 12. If less than $50,000, write $0.)

14.

Net Assets or Fund Balances Fee ...........................................................................................................................................

14.

(Line 13 multiplied by .0001. If the fee is less than $5, enter $0. Not to exceed $1,000. Round cents to the nearest whole dollar.)

Are you filing this report late?

Yes

No ..................................................................................................................

15.

(If yes, the late fee is a minimum of $20. You may owe more depending on how late the report is. See Instruction 15 for additional information or contact the

Charitable Activities Section at (971) 673-1880 to obtain late fee amount.)

16.

Total Amount Due ...................................................................................................................................................................

16.

(Add Lines 10, 14, and 15. Make check payable to the Oregon Department of Justice.)

17.

Attach a copy of the organization’s federal tax return and all supporting schedules and attachments that were filed with the IRS with the exception that

Form 990 & 990EZ filers do not need to attach a copy of their Schedule B. Also, if the organization did not file with the IRS, but had Total Revenue of

$25,000 or more, or Net Assets or Fund Balances of $50,000 or more, see the instructions as the organization is required to complete certain IRS

Forms for Oregon purposes only. If the attached return was not filed with the IRS, then mark any such return as “For Oregon Purposes Only." If your

organization files IRS Form 990-N (e-Postcard) please attach a copy or confirmation of its filing.

Under penalties of perjury, I declare that I have examined this return, including all accompanying forms, schedules, and attachments, and

Please

to the best of my knowledge and belief, it is true, correct, and complete.

Sign



Here

_______________________________________

_____________________

Signature of officer