Form Ct-12s - Tax Return For Split-Interest Trusts - 2016 Page 2
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1
2Section II.
Fee Calculation
8.
Charitable Distribution ..............................................................................................................
8.
(If no charitable distributions were made during the report year write $0. Otherwise, write the total of Lines 31 a, b and c
plus Line 36 from Form 5227, or the total of Line 18 plus Line 24 from Form 1041-A)
9.
Charitable Distribution Fee ......................................................................................................................................................
9.
(See chart below. Minimum fee is $20.)
Amount on Line 8
Charitable Distribution Fee
$0
-
$24,999
$20
$25,000
-
$49,999
$50
$50,000
-
$99,999
$90
$100,000
-
$249,999
$150
$250,000
-
$499,999
$200
$500,000
-
$999,999
$300
$1,000,000
or
more
$400
10.
Net Assets at the End of the Reporting Period ..........................................................................
10.
(Line 59b on Form 5227 or Line 45b on Form 1041-A)
11.
Net Assets Fee ........................................................................................................................................................................
11.
(Line 10 multiplied by .0001. If the fee is less than $5, write $0. Not to exceed $2,000. Round cents to the nearest whole dollar.)
Are you filing this report late?
Yes
No ..................................................................................................................
12.
12.
(If yes, the late fee is a minimum of $20. You may owe more depending on how late the report is. See Instruction 12 for additional information or contact the
Charitable Activities Section at (971) 673-1880 to obtain late fee amount.)
13.
Total Amount Due ...................................................................................................................................................................
13.
(Add Lines 9, 11, and 12. Make check payable to the Oregon Department of Justice.)
14.
Attach a copy of the trust’s federal returns and all supporting schedules and attachments.
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
Date
Title
_______________________________________
_______________________________________________________
Officer’s name (printed)
Address
_______________________________________________________
Phone
⇒
Paid
Preparer’s
_______________________________________
_____________________
_________________________
Use Only
Preparer’s signature
Date
Phone
_______________________________________
_______________________________________________________
Preparer’s name (printed)
Address
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