Assessment Fee Calculation Form - Idaho Department Of Finance - 2016

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2016 ASSESSMENT FEE CALCULATION FORM
Credit Union Name
________________________________________________
Person Completing Form
________________________________________________
Telephone Number
________________________________________________
(1) Total Assets as of December 31, 2015 Call Report.
__________________
$ 0.00
(2) TOTAL 2016 ASSESSMENT FEE DUE
__________________
Pursuant to schedule below.
******************************************************************************
ASSESSMENT FEE SCHEDULE FOR 2016
Asset Size
Fee
$0 to $1,000,000
-0-
$1,000,001 to $1,275,170,573
0.00016190 multiplied by amount on Line 1
$1,275,170,574 to $3,858,646,995
$206,450.12 plus 0.00004719 multiplied by amount of
assets on Line 1 over $1,275,170,573
Over $3,858,646,995
$328,364.37 plus 0.00001576 multiplied by amount of
assets on Line 1 over $3,858,646,995
Please submit this completed form, including the name and telephone number of the person
completing the form, along with your check payable to STATE OF IDAHO, DEPARTMENT
OF FINANCE, to:
DEPARTMENT OF FINANCE P.O. BOX 83720 BOISE, IDAHO 83720-0031
Please remit your payment by February 15, 2016. Thank you.

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