EF-502-D-R08-0514-38000349-1 BOE-502-D (P1) REV. 08 (05-14) CARMEN CHU Assessor-Recorder 1 Dr. Carlton B. Goodlett Place City Hall - Room 190 San Francisco, CA 94102-4698 CHANGE IN OWNERSHIP STATEMENT DEATH OF REAL PROPERTY OWNER This notice is a request for a completed Change in Ownership Statement. Failure to file this statement will result in the assessment of a penalty. NAME AND MAILING ADDRESS (Make necessary corrections to the printed name and mailing address) Section 480(b) of the Revenue and Taxation Code requires that the personal representative file this statement with the Assessor in each county where the decedent owned property at the time of death. File a separate statement for each parcel of real property owned by the decedent. NAME OF DECEDENT DATE OF DEATH YES NO STREET ADDRESS OF REAL PROPERTY Did the decedent have an interest in real property in this county? If YES, answer all questions. If NO, sign and complete the certification on page 2. CITY ZIP CODE ASSESSOR'S PARCEL NUMBER (APN) * DESCRIPTIVE INFORMATION R *If more than 1 parcel, attach separate sheet. (IF APN UNKNOWN) DISPOSITION OF REAL PROPERTY Succession without a will Probate Code 13650 distribution Affidavit of death of joint tenant R Copy of deed by which decedent acquired title is attached. Copy of decedent's most recent tax bill is attached. Deed or tax bill is not available; legal description is attached. TRANSFER INFORMATION Decedent's spouse Decree of distribution pursuant to will Action of trustee pursuant to terms of a trust R Check all that apply and list details below. Decedent's registered domestic partner Decedent's child(ren) or parent(s.) If qualified for exclusion from assessment, a Claim for Reassessment Exclusion for Transfer Between Parent and Child must be filed (see instructions). Decedent's grandchild(ren.) If qualified for exclusion from assessment, a Claim for Reassessment Exclusion for Transfer from Grandparent to Grandchild must be filed (see instructions). Cotenant to cotenant. If qualified for exclusion from assessment, an Affidavit of Cotenant Residency must be filed (see instructions). Other beneficiaries or heirs. A trust. NAME OF TRUSTEE ADDRESS OF TRUSTEE List names and percentage of ownership of all beneficiaries or heirs: NAME OF BENEFICIARY OR HEIRS RELATIONSHIP TO DECEDENT PERCENT OF OWNERSHIP RECEIVED This property has been or will be sold prior to distribution. (Attach the conveyance document and/or court order). NOTE: Sale of the property does not relieve the need to file a Claim for Reassessment Exclusion for Transfer Between Parent and Child if appropriate. THIS DOCUMENT IS NOT SUBJECT TO PUBLIC INSPECTION American LegalNet, Inc. www.FormsWorkFlow.com EF-502-D-R08-0514-38000349-2 BOE-502-D (P2) REV. 08 (05-14) YES NO Will the decree of distribution include distribution of an ownership interest in any legal entity that owns real property in this county? If YES, will the distribution result in any person or legal entity obtaining control of more than 50% of the ownership of that legal entity? YES NO If YES, complete the following section. NAME OF PERSON OR ENTITY GAINING SUCH CONTROL NAME AND ADDRESS OF LEGAL ENTITY YES NO NAME Was the decedent the lessor or lessee in a lease that had an original term of 35 years or more, including renewal options? If YES, provide the names and addresses of all other parties to the lease. MAILING ADDRESS CITY STATE ZIP CODE MAILING ADDRESS FOR FUTURE PROPERTY TAX STATEMENTS NAME ADDRESS CITY STATE ZIP CODE CERTIFICATION I certify (or declare) under penalty of perjury under the laws of the State of California that the information contained herein is true, correct and complete to the best of my knowledge and belief. t SIGNATURE OF PERSONAL REPRESENTATIVE TITLE E-MAIL ADDRESS PRINTED NAME OF PERSONAL REPRESENTATIVE DATE DAYTIME TELEPHONE ( ) IMPORTANT Section 480 of the Revenue and Taxation Code states, in part: Failure to file a Change in Ownership Statement within the time prescribed by law may result in a penalty of either $100 or 10% of the taxes applicable to the new base year value of the real property or manufactured home, whichever is greater, but not to exceed five thousand dollars ($5,000) if the property is eligible for the homeowners' exemption or twenty thousand dollars ($20,000) if the property is not eligible for the homeowners' exemption if that failure to file was not willful. This penalty will be added to the assessment roll and shall be collected like any other delinquent property taxes and subjected to the same penalties for nonpayment. INSTRUCTIONS (a) Whenever there occurs any change in ownership of real property or of a manufactured home that is subject to local property taxation and is assessed by the county assessor, the transferee shall file a signed change in ownership statement in the county where the real property or manufactured home is located, as provided for in subdivision (c). In the case of a change in ownership where the transferee is not locally assessed, no change in ownership statement is required. (b) The personal representative shall file a change in ownership statement with the county recorder or assessor in each county in which the decedent owned real property at the time of death that is subject to probate proceedings. The statement shall be filed prior to or at the time the inventory and appraisal is filed with the court clerk. In all other cases in which an interest in real property is transferred by reason of death, including a transfer through the medium of a trust, the change in ownership statement or statements shall be filed by the trustee (if the property was held in trust) or the transferee with the county recorder or assessor in each county in which the decedent owned an interest in real property within 150 days after the date of death. The above requested information is required by law. Please reference the following: · · · Passage of Decedent's Property: Beneficial interest passes to the decedent's heirs effectively on the decedent's date of death. However, a document must be recorded to vest title in the heirs. An attorney should be consulted to discuss the specific facts of your situation. Change in Ownership: California Code of Regulations, Title 18, Rule 462.260(c), states in part that "[i]nheritance (by will or intestate succession)" shall be "the date of death of decedent." Inventory and Appraisal: Probate Code, Section 8800, states in part, "Concurrent with the filin