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STATE OF CALIFORNIA DEPARTMENT OF JUSTICE
RRF-1 PAGE 1 of 5
(Rev. 02/2021)
MAIL TO: (For Registry Use Only)
Registry of Charitable Trusts ANNUAL REGISTRATION RENEWAL FEE REPORT
P.O. Box 903447
Sacramento, CA 94203-4470 TO ATTORNEY GENERAL OF CALIFORNIA
STREET ADDRESS: Sections 12586 and 12587, California Government Code
1300 I Street 11 Cal. Code Regs. sections 301-306, 309, 311, and 312
Sacramento, CA 95814 Failure to submit this report annually no later than four months and fifteen days after the end of the
(916) 210-6400 organization's accounting period may result in the loss of tax exemption and the assessment of a
minimum tax of $800, plus interest, and/or fines or filing penalties. Revenue & Taxation Code section
WEBSITE ADDRESS:
www.oag.ca.gov/charities 23703; Government Code section 12586.1. IRS extensions will be honored.
Check if:
Name of Organization Change of address
Amended report
List all DBAs and names the organization uses or has used
Address (Number and Street) State Charity Registration Number
City or Town, State, and ZIP Code Corporation or Organization No.
Telephone Number E-mail Address Federal Employer ID No.
ANNUAL REGISTRATION RENEWAL FEE SCHEDULE (11 Cal. Code Regs. sections 301-307, 311, and 312)
Make Check Payable to Department of Justice
Total Revenue Fee Total Revenue Fee Total Revenue Fee
Less than $50,000 $25 Between $250,001 and $1 million $100 Between $20,000,001 and $100 million $800
Between $50,000 and $100,000 $50 Between $1,000,001 and $5 million $200 Between $100,000,001 and $500 million $1,000
Between $100,001 and $250,000 $75 Between $5,000,001 and $20 million $400 Greater than $500 million $1,200
PART A - ACTIVITIES
For your most recent full accounting period (beginning / / ending / / ) list:
Total Revenue $
(including noncash contributions) Noncash Contributions $ Total Assets $
Program Expenses $ Total Expenses $
PART B - STATEMENTS REGARDING ORGANIZATION DURING THE PERIOD OF THIS REPORT
Note: All questions must be answered. If you answer "yes" to any of the questions below, you must attach a separate page
providing an explanation and details for each "yes" response. Please review RRF-1 instructions for information required. Yes No
1. 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?
2. During this reporting period, was there any theft, embezzlement, diversion or misuse of the organization's charitable property or funds?
3. During this reporting period, were any organization funds used to pay any penalty, fine or judgment?
4. During this reporting period, were the services of a commercial fundraiser, fundraising counsel for charitable purposes, or commercial
coventurer used?
5. During this reporting period, did the organization receive any governmental funding?
6. During this reporting period, did the organization hold a raffle for charitable purposes?
7. Does the organization conduct a vehicle donation program?
8. Did the organization conduct an independent audit and prepare audited financial statements in accordance with
generally accepted accounting principles for this reporting period?
9. At the end of this reporting period, did the organization hold restricted net assets, while reporting negative unrestricted net assets?
I declare under penalty of perjury that I have examined this report, including accompanying documents, and to the best of my knowledge and
belief, the content is true, correct and complete, and I am authorized to sign.
Signature of Authorized Agent Printed Name Title Date
