BOE-502-A (P1) REV. 12 (05-13) EF-502-A-R12-0513-36001073-1 Bob Dutton Assessor-Recorder-County Clerk County of San Bernardino Assessor's Office 172 West Third Street San Bernardino, CA 92415-0310 www.sbcounty.gov/assessor (909) 387-8307 - 1-877-885-7654 PRELIMINARY CHANGE OF OWNERSHIP REPORT To be completed by the transferee (buyer) prior to a transfer of subjectproperty,inaccordancewithsection480.3oftheRevenue and Taxation Code. A Preliminary Change of Ownership Report mustbefiledwitheachconveyanceintheCountyRecorder'soffice forthecountywheretheproperty is located. NAMEANDMAILINGADDRESSOFBUYER/TRANSFEREE (Make necessary corrections to the printed name and mailing address) ASSESSOR'SPARCELNUMBER SELLER/TRANSFEROR BUYER'SDAYTIMETELEPHONENUMBER ( STREETADDRESSORPHYSICALLOCATIONOFREALPROPERTY MAILPROPERTYTAXINFORMATIONTO(NAME) ADDRESS ) BUYER'SEMAILADDRESS CITY MO STATE ZIPCODE DAY YEAR YES NO Thispropertyisintendedasmyprincipalresidence.IfYES,pleaseindicatethedateofoccupancy orintendedoccupancy. PART 1. TRANSFER INFORMATION YES NO Please complete all statements. Thissectioncontainspossibleexclusionsfromreassessmentforcertaintypesoftransfers. A. Thistransferissolelybetweenspouses(addition or removal of a spouse, death of a spouse, divorce settlement, etc.). B. ThistransferissolelybetweendomesticpartnerscurrentlyregisteredwiththeCaliforniaSecretaryofState(addition or removal of a partner, death of a partner, termination settlement, etc.). * C. Thisisatransfer: between parent(s) and child(ren) from grandparent(s) to grandchild(ren). * D. Thistransferistheresultofacotenant'sdeath.Dateofdeath___________________________ * E. This transaction is to replace a principal residence by a person 55 years of age or older. Withinthesamecounty? YES NO * F. ThistransactionistoreplaceaprincipalresidencebyapersonwhoisseverelydisabledasdefinedbyRevenueandTaxationCode NO G. This transaction is only a correction of the name(s) of the person(s) holding title to the property (e.g., a name change upon marriage). IfYES,pleaseexplain: H. Therecordeddocumentcreates,terminates,orreconveysalender'sinterestintheproperty. I. Thistransactionisrecordedonlyasarequirementforfinancingpurposesortocreate,terminate,orreconveyasecurityinterest (e.g., cosigner).IfYES,pleaseexplain: J. Therecordeddocumentsubstitutesatrusteeofatrust,mortgage,orothersimilardocument. K. Thisisatransferofproperty: 1. to/fromarevocabletrustthatmayberevokedbythetransferorandisforthebenefitof thetransferor,and/or thetransferor'sspouse registereddomesticpartner. 2. to/fromatrustthatmayberevokedbythecreator/grantor/trustorwhoisalsoajointtenant,andwhich namestheotherjointtenant(s)asbeneficiarieswhenthecreator/grantor/trustordies. 3. to/fromanirrevocabletrustforthebenefitofthe creator/grantor/trustorand/or grantor's/trustor'sspouse grantor's/trustor'sregistereddomesticpartner. section69.5.Withinthesamecounty? YES L. Thispropertyissubjecttoaleasewitharemainingleasetermof35yearsormoreincludingwrittenoptions. M. This is a transfer between parties in which proportional interests of the transferor(s) and transferee(s) in each and every parcel beingtransferredremainexactlythesameafterthetransfer. N. Thisisatransfersubjecttosubsidizedlow-incomehousingrequirementswithgovernmentallyimposedrestrictions. * O.Thistransferistothefirstpurchaserofanewbuildingcontaininganactivesolarenergysystem. * PleaserefertotheinstructionsforPart1. Please provide any other information that will help the Assessor understand the nature of the transfer. THIS DOCUMENT IS NOT SUBJECT TO PUBLIC INSPECTION American LegalNet, Inc. www.FormsWorkFlow.com EF-502-A-R12-0513-36001073-2 BOE-502-A (P2) REV. 12 (05-13) PART 2. OTHER TRANSFER INFORMATION A. Dateoftransfer,ifotherthanrecordingdate: B. Typeoftransfer: Purchase Foreclosure Gift Tradeorexchange Check and complete as applicable. Merger,stock,orpartnershipacquisition(FormBOE-100-B) Inheritance.Dateofdeath: Contractofsale.Dateofcontract: Sale/leaseback Creationofalease Assignment of a lease Original term in years (including written options): Other.Pleaseexplain: C. Onlyapartialinterestinthepropertywastransferred. A. Totalpurchaseprice Terminationofalease.Dateleasebegan: Remaining term in years (including written options): IfYES,indicatethepercentagetransferred: % YES NO PART 3. PURCHASE PRICE AND TERMS OF SALE Check and complete as applicable. $_______________ B. Cashdownpaymentorvalueoftradeorexchangeexcludingclosingcosts C. Firstdeedoftrust@______%interestfor______years.Monthlypayment$_____________ FHA(___DiscountPoints) Cal-Vet VA(___DiscountPoints) Amount$_______________ Amount$_______________ Variable rate Fixedrate Bank/Savings&Loan/CreditUnion Loancarriedbyseller Amount$_______________ Balloonpayment$_____________ Duedate:_____________ D. Seconddeedoftrust@______%interestfor______years.Monthlypayment$_____________ Fixedrate Variable rate Bank/Savings&Loan/CreditUnion Duedate:_____________ Loancarriedbyseller YES NO Outstandingbalance$_______________ Phonenumber: Balloonpayment$_____________ E. WasanImprovementBondorotherpublicfinancingassumedbythebuyer? G.Thepropertywaspurchased: Direct from seller Other.Pleaseexplain: Throughrealestatebroker.Brokername: F. Amount,ifany,ofrealestatecommissionfeespaidbythebuyerwhicharenotincludedinthepurchaseprice From a family member-Relationship ( $_______________ ) H. Pleaseexplainanyspecialterms,sellerconcessions,broker/agentfeeswaived,financing,andanyotherinformation(e.g.,buyerassumedthe existingloanbalance)thatwouldassisttheAssessorinthevaluationofyourproperty. A. Type of property transferred Single-family residence PART 4. PROPERTY INFORMATION Check and complete as applicable. Co-op/Own-your-own Condominium Timeshare Manufacturedhome Unimprovedlot Commercial/Industrial Multiple-familyresidence.Numberofunits: Other.Description:(i.e.,timber,mineral,waterrights,etc.) B. YES NO Personal/businessproperty,orincentives,providedbysellertobuyerareincludedinthepurchaseprice.Examplesofpersonal propertyarefurniture,farmequipment,machinery,etc.Examplesofincentivesareclubmemberships,etc.Attachlistifavailable. $ $ Incentives $ NO Amanufacturedhomeisincludedinthepurchaseprice. NO Themanufacturedhomeissubjecttolocalpropertytax.IfNO,enterdecalnumber: NO Thepropertyproducesrentalorotherincome. Lease/rent Contract Good Mineral rights Average Other: Fair Poor IfYES,enterthevalueofthepersonal/businessproperty: C. YES YES D. YES IfYES,enterthevalueattributedtothemanufacturedhome: IfYES,theincomeisfrom: E. Thec