Form 150-800-333 "Application to Be Listed in the Income Tax Booklet to Receive Checkoff Contributions" - Oregon

What Is Form 150-800-333?

This is a legal form that was released by the Oregon Department of Revenue - a government authority operating within Oregon. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2018;
  • The latest edition provided by the Oregon Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form 150-800-333 by clicking the link below or browse more documents and templates provided by the Oregon Department of Revenue.

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Download Form 150-800-333 "Application to Be Listed in the Income Tax Booklet to Receive Checkoff Contributions" - Oregon

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Clear form
Oregon Charitable Checkoff Commission
Application to be listed in the income tax booklet to receive checkoff contributions
Instructions:
• Your application must be submitted by July 1 to the Charitable Checkoff Commission.
• Your 10,000 signatures are also due on July 1 to the Charitable Checkoff Commission.
• For questions, call the Department of Revenue at (503) 945-8633.
Name of organization
Street address
City
State
ZIP code
Phone
Fax
Business hours
(
)
(
)
Names and addresses of officers of the organization, including the person who is principal in the solicitation activities of the organization
Please submit the following with your application:
Complete financial statements for the last two fiscal years. Umbrella organizations representing a group of affiliates
must submit combined financial statements.
• A letter from the Department of Justice, stating that your organization is in compliance with Oregon Revised Statutes
(ORS) 128.610–128.769. For questions, contact the Charitable Activities Section, Oregon Department of Justice, 100
SW Market St., Portland OR 97201-5702, phone (971) 673-1880.
• Evidence that your organization is a 501(C)(3) organization under the Internal Revenue Code.
• Evidence that your organization received at least $1 million in gross income in the year prior to application or a fiscal
period ending in that year. Include pages 1–4 only of IRS Form 990 income tax return.
• A narrative statement addressing the following:
— A brief history of your organization.
— How your organization supports private charitable causes and/or engages in private activities that are consistent
with state policies and programs.
— How checkoff resources will fund programs resulting in benefits to the state that are unlikely to occur under existing
public and private programs, and how your organization will ensure that these programs are available statewide.
Your organization must gather 10,000 signatures from registered Oregon voters. You must use the Charitable
Checkoff Commission form for this purpose. Call the Department of Revenue at (503) 945-8633 to obtain this form
or visit our website at www.oregon.gov/dor.
Submit your completed application and signature petitions to:
Advisor
Charitable Checkoff Commission
Oregon Department of Revenue
955 Center Street NE
Salem OR 97301-2555
Application and signatures due July 1.
150-800-333 (Rev. 01-18)
Clear form
Oregon Charitable Checkoff Commission
Application to be listed in the income tax booklet to receive checkoff contributions
Instructions:
• Your application must be submitted by July 1 to the Charitable Checkoff Commission.
• Your 10,000 signatures are also due on July 1 to the Charitable Checkoff Commission.
• For questions, call the Department of Revenue at (503) 945-8633.
Name of organization
Street address
City
State
ZIP code
Phone
Fax
Business hours
(
)
(
)
Names and addresses of officers of the organization, including the person who is principal in the solicitation activities of the organization
Please submit the following with your application:
Complete financial statements for the last two fiscal years. Umbrella organizations representing a group of affiliates
must submit combined financial statements.
• A letter from the Department of Justice, stating that your organization is in compliance with Oregon Revised Statutes
(ORS) 128.610–128.769. For questions, contact the Charitable Activities Section, Oregon Department of Justice, 100
SW Market St., Portland OR 97201-5702, phone (971) 673-1880.
• Evidence that your organization is a 501(C)(3) organization under the Internal Revenue Code.
• Evidence that your organization received at least $1 million in gross income in the year prior to application or a fiscal
period ending in that year. Include pages 1–4 only of IRS Form 990 income tax return.
• A narrative statement addressing the following:
— A brief history of your organization.
— How your organization supports private charitable causes and/or engages in private activities that are consistent
with state policies and programs.
— How checkoff resources will fund programs resulting in benefits to the state that are unlikely to occur under existing
public and private programs, and how your organization will ensure that these programs are available statewide.
Your organization must gather 10,000 signatures from registered Oregon voters. You must use the Charitable
Checkoff Commission form for this purpose. Call the Department of Revenue at (503) 945-8633 to obtain this form
or visit our website at www.oregon.gov/dor.
Submit your completed application and signature petitions to:
Advisor
Charitable Checkoff Commission
Oregon Department of Revenue
955 Center Street NE
Salem OR 97301-2555
Application and signatures due July 1.
150-800-333 (Rev. 01-18)