BOE-502-D (P1) REV. 03 (08-09) CHANGE IN OWNERSHIP STATEMENT DEATH OF REAL PROPERTY OWNER ASSESSOR’S OFFICE 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. 1010 Tenth Street, Suite 2400 Modesto, CA 95354 Phone: (209) 525-6461 l Fax: (209) 525-6586 www.stancounty.com/assessor David E. Cogdill Sr., Assessor 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 YES NO DATE OF DEATH 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. STREET ADDRESS OF REAL PROPERTY DESCRIPTIVE INFORMATION CITY R (IF APN UNKNOWN) ZIP CODE ASSESSOR’S PARCEL NUMBER (APN) DISPOSITION OF REAL PROPERTY Copy of deed by which decedent acquired title is attached. Succession without a will Copy of decedent’s most recent tax bill is attached. Probate Code 13650 distribution Deed or tax bill is not available; legal description is attached. Affidavit of death of joint tenant TRANSFER INFORMATION R R Decree of distribution pursuant to will Action of trustee pursuant to terms of a trust Check all that apply and list details below. Decedent’s spouse 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.) Other beneficiaries. A trust. NAME OF TRUSTEE ADDRESS OF TRUSTEE List names and percentage of ownership of all beneficiaries: NAME OF BENEFICIARY 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.) CONTINUED ON PAGE 2 THIS DOCUMENT IS NOT SUBJECT TO PUBLIC INSPECTION American LegalNet, Inc. www.FormsWorkFlow.com BOE-502-D (P2) REV. 03 (08-09) NO Will the decree of distribution include distribution of an ownership interest in any legal entity that owns real property YES YES NO NO YES MAILING ADDRESS FOR FUTURE PROPERTY TAX STATEMENTS 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. DA E ( ) INSTRUCTIONS the same penalties for nonpayment. 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. shall be "the date of death of decedent." the decedent owned property at the time of death." (209) 525-6461 American LegalNet, Inc. www.FormsWorkFlow.com