"Assessment Fee Calculation Form for Idaho Financial Institutions" - Idaho

Assessment Fee Calculation Form for Idaho Financial Institutions is a legal document that was released by the Idaho Department of Finance - a government authority operating within Idaho.

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2021 ASSESSMENT FEE CALCULATION FORM
FOR IDAHO FINANCIAL INSTITUTIONS
Institution Name:
Person Completing Form:
Phone Number:
1. OFFICE FEE:
a. Number of banking offices, including the head office:
____________
(Do not include loan production, administrative, or operations offices.)
b. Office fee of $100 per office:
$ 100
c. TOTAL OFFICE FEE (Multiply line 1a by 1b)
____________
2. ASSET FEE:
a. Total Assets (in thousands) from December 31, 2020 Call Report:
____________
b. Outstanding balance of Paycheck Protection Program loans:
____________
c. Total Assets for assessment fee calculation (Subtract line 2b from line 2a):
____________
d. Base Fee Due (per attached fee schedule):
____________
e. Amount due in excess of base fee (per attached fee schedule):
____________
f. TOTAL ASSET FEE (Add lines 2d and 2e):
____________
3. TOTAL ASSET AND OFFICE FEE (Add lines 1c and 2f):
____________
4. FORTY PERCENT (40%) ASSESSMENT REDUCTION (Multiply line 3 by .40):
____________
5. TOTAL ASSESSMENT FEE DUE FOR 2021 (Subtract line 4 from line 3):
____________
Please submit this completed form, including the name and telephone number of the person completing the form, along
with your check payable to STATE OF IDAHO, DEPARTMENT OF FINANCE, to:
DEPARTMENT OF FINANCE P.O. BOX 83720 BOISE, IDAHO 83720-0031
Please remit your payment within 30 days of receipt of this notice. Thank you.
2021 ASSESSMENT FEE CALCULATION FORM
FOR IDAHO FINANCIAL INSTITUTIONS
Institution Name:
Person Completing Form:
Phone Number:
1. OFFICE FEE:
a. Number of banking offices, including the head office:
____________
(Do not include loan production, administrative, or operations offices.)
b. Office fee of $100 per office:
$ 100
c. TOTAL OFFICE FEE (Multiply line 1a by 1b)
____________
2. ASSET FEE:
a. Total Assets (in thousands) from December 31, 2020 Call Report:
____________
b. Outstanding balance of Paycheck Protection Program loans:
____________
c. Total Assets for assessment fee calculation (Subtract line 2b from line 2a):
____________
d. Base Fee Due (per attached fee schedule):
____________
e. Amount due in excess of base fee (per attached fee schedule):
____________
f. TOTAL ASSET FEE (Add lines 2d and 2e):
____________
3. TOTAL ASSET AND OFFICE FEE (Add lines 1c and 2f):
____________
4. FORTY PERCENT (40%) ASSESSMENT REDUCTION (Multiply line 3 by .40):
____________
5. TOTAL ASSESSMENT FEE DUE FOR 2021 (Subtract line 4 from line 3):
____________
Please submit this completed form, including the name and telephone number of the person completing the form, along
with your check payable to STATE OF IDAHO, DEPARTMENT OF FINANCE, to:
DEPARTMENT OF FINANCE P.O. BOX 83720 BOISE, IDAHO 83720-0031
Please remit your payment within 30 days of receipt of this notice. Thank you.