Form Ct-12f - Tax Return For Foreign Corporations - 2004 Page 2

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Section II.

Fee Calculation

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

(If Oregon revenue is unknown, write the total revenue from Line 12 on Form 990; Line 9 on Form 990-EZ; or Part I, Line

12a on Form 990-PF.)

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.

Total Oregon Program Service Expenses ....................................

11.

(See Instructions.)

12.

Oregon Net Assets or Fund Balances at the End of the

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

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

Line 21 on Form 990; Line 21 on Form 990-EZ; or Part III, Line 6 on Form 990-PF.)

13.

Oregon Net Fixed Assets Used to Conduct Charitable Activities .

13.

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

14.

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

14.

(Line 12 minus line 13. If less than $50,000, write $0.)

15.

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

15.

(Line 14 multiplied by .0001. If the fee is less than $5, enter $0. Not to exceed $1,000. Round cents to the nearest whole dollar.)

16.

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

16.

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

17.

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

17.

(Add Lines 10, 15, and 16. Make check payable to the Oregon Department of Justice.)

18.

Attach a copy of the organization’s federal tax returns 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, see the instructions as the organization may be required to complete

certain IRS Forms for Oregon purposes only. If the return was not filed with the IRS, then mark any such returns 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