OFFICE OF ASSESSOR COUNTY OF ALAMEDA 1221 Oak St., County Administration Building Oakland, California 94612-4288 (510) 272-3787 / FAX (510) 272-3803 RON THOMSEN A S S ESSOR Statement of Death of Real Property Owner Filing this Statement of Death of Real Property Owner with our office may assist us in determining the property does not require reassessment. The filing of a Preliminary Change of Ownership Report will satisfy the requirements of California State Revenue and Taxation Code Section 480(b). Please complete the following information and submit the forms timely. A delay in returning the forms may result in the unnecessary reassessment and subsequent additional tax bill(s) of the property. 1. Name of Decedent:__________________________________________________________________________ 2. Probate No.:______________________________________ 3. Date of Death___________________________ 4. Address of Property:________________________________________________________________________ 5. Assessor’s Parcel Number(s) (APN)____________________________________________________________ 6. Name(s) of Heir(s) or Devisee(s) Relationship to Decedent % of Property to be Acquired _______________________________ ___________________ ____________ _______________________________ ___________________ ____________ ________________________________ ___________________ ____________ ________________________________ ___________________ ____________ 7. Future tax related correspondence, including tax bills for the Heirs/Devisees, should be sent to: Name:____________________________________________________________________________________ Address:__________________________________________________________________________________ City:________________________________________________ State:_________ Zip Code:_______________ The Assessor’s Office may contact you for additional information regarding this transaction. I certify (or declare) under penalty under the laws of the State of California that the foregoing and all information hereon, including any accompanying documents, is true, correct and complete to the best of my knowledge and belief. _________________________________________________________ ____________________ Signature of ( )Executor/Administrator ( ) Attorney Date ________________________________________ Print Name South County Toll Free (800) 660-7725 (_______)_____________________________ Daytime Telephone Number www.acgov.org/assessor American LegalNet, Inc. www.FormsWorkflow.com