Form Ct-Rrf-1 - Registration/renewal Fee Report - Attorney General Of California - 2001

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MAIL TO:

2001

Registry of Charitable Trusts

REGISTRATION/RENEWAL FEE REPORT

P.O. Box 903447

Sacramento, CA 94203-4470

TO ATTORNEY GENERAL OF CALIFORNIA

Sections 12586 and 12587, California Government Code

STREET ADDRESS:

11 CCR Sections 311 and 312

1300 I Street, Room 1130

Sacramento, CA 95814

Failure to submit this report annually no later than four months and fifteen

days after the end of the organization’s accounting period will result in the

Telephone: (916) 445-2021

loss of tax exemption and the assessment of a minimum tax of $800, plus

interest, and/or fines or filing penalties as defined in Government Code

WEBSITE ADDRESS:

Section 12586.1 (recently enacted).

RRF-1 EXTENSIONS WILL NOT BE GRANTED

Enter State Charity Registration Number, Name, and Address of Organization Below:

Check if:

Q Q Q Q Change of address

Q Q Q Q Initial report

State Charity Registration Number

Q Q Q Q Amended report

Q Q Q Q Final report

Name of Organization

Corporate or Organization No.

Address (Number and Street)

Federal Employer I.D. No.

City or Town, State and ZIP Code

PART A - ACTIVITIES

Yes

During your most recent full accounting period did your gross receipts or total assets equal $100,000 or

more?

(a)

If the answer is yes, you are required by Title 11 of the California Code of Regulations, §§311 and 312, to

attach a check in the amount of $25.00 to this report. Make check payable to Department of Justice.

For your most recent full accounting period (beginning ______/______/______ ending _____/_____/______) list:

Gross receipts $_____________________ Total assets $____________________ Actual _____ Estimated_____

PART B - STATEMENTS REGARDING ORGANIZATION DURING THE PERIOD OF THIS REPORT

Note:

If you answer “yes” to any of the questions below, you must attach a separate sheet providing an explanation and

details for each “yes” response. Please review RRF-1 Instructions for information required.

Yes

During this reporting period, were there any contracts, loans, leases or other financial transactions between

the organization and any officer, director or trustee thereof either directly or with an entity in which any such

officer, director or trustee had any financial interest?

During this reporting period, was there any theft, embezzlement, diversion or misuse of the organization’s

charitable property or funds?

During this reporting period, did nonprogram expenditures exceed at least 50% of gross revenues?

During this reporting period, were any organization funds used to pay any penalty, fine or judgment? If you

filed a Form 4720 with the Internal Revenue Service, attach a copy.

During this reporting period, were the services of a professional fundraiser or fundraising counsel used? If

“yes,” provide an attachment listing the name, address, and telephone number of the service provider.

During this reporting period, did the organization receive any governmental funding? If so, provide an

attachment listing the name of the agency, mailing address, contact person, and telephone number.

Organization’s area code and telephone number (

) ________________ - _____________________________________________________________

I declare under penalty of perjury that I have examined this report, including accompanying documents, and to the best of my knowledge and belief, it is true,

correct and complete.

Signature of authorized officer

Printed Name

Title

Date

Clear Form

Form ct - RRF-1 (REV. 11/2000)