Form Ct-12 - Fee Calculation For Oregon Corporations And Certain Trusts - 2005 Page 2

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Section II.

Fee Calculation

Total Revenue...........................................................................................................................

(From Line 12 on Form 990; Line 9 on Form 990-EZ; Part I, Line 12a on Form 990-PF; Line 9 on Form 1041 or Form 1041-

A; or see page 3 of the instructions if no federal tax return was prepared.)

10.

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

10.

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

Amount on Line 17

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.

Net Assets or Fund Balances at End of the Reporting Period ......

11.

(From Line 21 on Form 990 or Form 990-EZ, or Part III, Line 6 on Form 990-PF; or

see page 4 to calculate.)

12.

Net Fixed Assets Used to Conduct Charitable Activities ...........

12.

(Generally, from Line 57c on Form 990, Line 23B on Form 990-EZ or Part II, Line

14b on Form 990-PF; or see page 4 to calculate. See instructions if organization

owns income-producing assets.)

13.

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

13.

(Line 11 minus Line 12. If Line 11 minus Line 12 is 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.)

15.

Delinquency Penalty ................................................................................................................................................................

15.

(If report is submitted after the due date, the delinquency penalty is $20.)

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."

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