SIGNATURE OF TRANSFEROR OR LEGAL REPRESENTATIVESIGNATURE OF TRANSFEROR OR LEGAL REPRESENTATIVEMAILING ADDRESS ()BOE-58-AH (P1) REV. 1 (0-1) CLAIM FOR REASSESSMENT EXCLUSION FORTRANSFER BETWEEN PARENT AND CHILDA. PROPERTYASSESSOR?S PARCEL NUMBERPROPERTY ADDRESS CITYRECORDER?S DOCUMENT NUMBER DATE OF PURCHASE OR TRANSFERPROBATE NUMBER (if applicable) DATE OF DEATH (if applicable) DATE OF DECREE OF DISTRIBUTION (if applicable)Was this property the transferor?s principal residence? Yes NoIf yes, please check which of the following exemptions was granted or was eligible to be granted on this property: Homeowners? Exemption Yes No6.Was only a partial interest in the property transferred?If yes, please attach a list of all previous transfers that qualiŞed for this exclusion. (This list should include for each property: the County,Assessor?s parcel number, address, date of transfer, names of all the transferees/buyers, and family relationship. Transferor?s principalresidence must be identiŞed.) Yes No If %7.Was this property owned in joint tenancy? Yes NoB. TRANSFEROR(S)/SELLER(S) (additional transferors please complete ?B? on the reverse)8.CERTIFICATIONI certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing and all information hereon, including any THIS DOCUMENT IS NOT SUBJECT TO PUBLIC INSPECTION(Please complete applicable information on reverse side.) EF-58-AH-R18-0617-04000190-1 BOE-58-AH (P2) REV. 1 (0-1)C. TRANSFEREE(S)/BUYER(S) (additional transferees please complete ?C? below)I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing and all information hereon, including anyaccompanying statements or documents, is true and correct to the best of my knowledge and that I am the parent or child (or transferee?s legalrepresentative) of the transferors listed in Section B; and that all of the transferees are eligible transferees within the meaning of section 63.1 ofthe Revenue and Taxation Code. NAME SOCIAL SECURITY NUMBER SIGNATURE RELATIONSHIPNAME RELATIONSHIPCERTIFICATION1.Print full name(s) of transferee(s) 2.Family relationship(s) to transferor(s) If adopted, age at time of adoption If stepparent/stepchild relationship is involved, was parent still married to or in a registered domestic partnership (registered meansregistered with the California Secretary of State) with stepparent on the date of purchase or transfer? Yes NoIf no, was the marriage or registered domestic partnership terminated by: Death Divorce/Termination of partnershipIf terminated by death, had the surviving stepparent remarried or entered into a registered domestic partnership as of the date of purchaseor transfer? Yes NoIf in-law relationship is involved, was the son-in-law or daughter-in-law still married to or in a registered domestic partnership with thedaughter or son on the date of purchase or transfer? Yes NoIf no, was the marriage or registered domestic partnership terminated by: Death Divorce/Termination of partnershipIf terminated by death, had the surviving son-in-law or daughter-in-law remarried or entered into a registered domestic partnership as ofthe date of purchase or transfer? Yes No3.ALLOCATION OF EXCLUSION (If the full cash value of the real property transferred exceeds the one million dollar value exclusion, thetransferee must specify on an attachment to this claim the amount and allocation of the exclusion that is being sought.)SIGNATURE OF TRANSFEREE OR LEGAL REPRESENTATIVEMAILING ADDRESS( )CITY, STATE, ZIPEMAIL ADDRESSDATEDAYTIME PHONE NUMBER C. TRANSFEREE(S)/BUYER(S) (additional transferees please complete ?C? below)3.ALLOCATION OF EXCLUSION (If the full cash value of the real property transferred exceeds the one million dollar value exclusion, thetransferee must specify on an attachment to this claim the amount and allocation of the exclusion that is being sought.)CERTIFICATIONI certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing and all information hereon, including anyaccompanying statements or documents, is true and correct to the best of my knowledge and that I am the parent or child (or transferee?s legalrepresentative) of the transferors listed in Section B; and that all of the transferees are eligible transferees within the meaning of section 63.1 ofthe Revenue and Taxation Code. Note: The Assessor may contact you for additional information.B. ADDITIONALTRANSFEROR(S)/SELLER(S) (continued)C. ADDITIONAL TRANSFEREE(S)/BUYER(S) (continued) EF-58-AH-R18-0617-04000190-2 CLAIM FOR REASSESSMENT EXCLUSION FOR TRANSFER BETWEEN PARENT AND CHILDRevenue and Taxation Code, Section 63.1IMPORTANT: In order to qualify for this exclusion, a claim form must be completed and signed by the transferors and a transferee and filed with the Assessor. A claim form is timely filed if it is filed within three years after the date of purchase or transfer, or prior to the transfer of the real property to a third party, whichever is earlier. If a claim form has not been filed by the date specified in the preceding sentence, it will be timely if filed within six months after the date of mailing of a notice of supplemental or escape assessment for this property. If a claim is not timely filed, the exclusion will be granted beginning with the calendar year in which you file your claim. Complete all of Sections A, B, and C and answer each question or your claim may be denied. Proof of eligibility, including a copy of the transfer document, trust, or will, may be required. In situations where all information is not known by the due date, the parties should file this claim with as much information as possible, and later amend the claim with any revised information. Please note:1. This exclusion only applies to transfers that occur on or after November 6, 1986;2. In order to qualify, the real property must be transferred from parents to their children or children to their parents;3. If you do not complete and return this form, it may result in this property being reassessed.4. California law provides, with certain limitations, that a ?change in ownership? does not include the purchase or transfer of:?The principal residence between parents and children, and/or?The first $1,000,000 of the factored base year value of other real property between parents and children.NOTE: Effective January 1, 2009, Revenue and Taxation Code Section 63.1(j) allows a county board of supervisors to authorize a one-timeprocessing fee of not more than $175 to recover costs incurred by the county assessor due to the failure of an eligible transferee to Şle a claim forthe parent-child change in ownership exclusion after two written requests have been sent to an eligible transferee by the county assessor. BOE-58-AH (P3) REV. 1 (0-1) EF-58-AH-R18-0617-04000190-3