BOE-502-AH (P1) REV. 13 (07-10) CHANGE IN OWNERSHIP STATEMENT This statement represents a written request from the Assessor. )DLOXUH WR ¿OH ZLOO UHVXOW LQ WKH DVVHVVPHQW RI D SHQDOW\ FILE THIS STATEMENT BY: IMPORTANT NOTICE 7KH ODZ UHTXLUHV DQ\ WUDQVIHUHH DFTXLULQJ DQ LQWHUHVW LQ UHDO SURSHUW\ RU PDQXIDFWXUHG KRPH VXEMHFW WR ORFDO SURSHUW\ WD[DWLRQ DQG WKDW LV DVVHVVHG E\ WKH FRXQW\ DVVHVVRU WR ¿OH D &KDQJH LQ 2ZQHUVKLS 6WDWHPHQW ZLWK WKH &RXQW\ 5HFRUGHU RU $VVHVVRU 7KH &KDQJH LQ 2ZQHUVKLS 6WDWHPHQW PXVW EH ¿OHG DW WKH WLPH RI UHFRUGLQJ RU LI WKH WUDQVIHU LV QRW UHFRUGHG ZLWKLQ  GD\V RI WKH GDWH RI WKH FKDQJH LQ RZQHUVKLS H[FHSW WKDW ZKHUH WKH FKDQJH LQ RZQHUVKLS KDV RFFXUUHG E\ UHDVRQ RI GHDWK WKH VWDWHPHQW VKDOO EH ¿OHG ZLWKLQ  GD\V DIWHU WKH GDWH RI GHDWK RU LI WKH HVWDWH LV SUREDWHG VKDOO EH ¿OHG DW WKH WLPH WKH LQYHQWRU\ DQG DSSUDLVDO LV ¿OHG 7KH IDLOXUH WR ¿OH D &KDQJH LQ 2ZQHUVKLS 6WDWHPHQW ZLWKLQ  GD\V IURP WKH GDWH RI D ZULWWHQ UHTXHVW E\ WKH $VVHVVRU UHVXOWV LQ D SHQDOW\ RI HLWKHU  RQH KXQGUHG GROODUV   RU   SHUFHQW RI WKH WD[HV DSSOLFDEOH WR WKH QHZ EDVH \HDU YDOXH UHÀHFWLQJ WKH FKDQJH LQ RZQHUVKLS RI WKH UHDO SURSHUW\ RU PDQXIDFWXUHG KRPH ZKLFKHYHU LV JUHDWHU EXW QRW WR H[FHHG WZR WKRXVDQG ¿YH KXQGUHG GROODUV   LI WKDW IDLOXUH WR ¿OH ZDV QRW ZLOOIXO 7KLV SHQDOW\ ZLOO EH DGGHG WR WKH DVVHVVPHQW UROO DQG VKDOO EH FROOHFWHG OLNH DQ\ RWKHU GHOLQTXHQW SURSHUW\ WD[HV DQG EH VXEMHFW WR WKH VDPH SHQDOWLHV IRU QRQSD\PHQW SELLER/TRANSFEROR ASSESSOR'S PARCEL NUMBER BUYER/TRANSFEREE ( BUYER’S DAYTIME TELEPHONE NUMBER ) STREET ADDRESS OR PHYSICAL LOCATION OF REAL PROPERTY MAIL PROPERTY TAX INFORMATION TO (NAME) ADDRESS YES CITY STATE ZIP CODE NO This property is intended as my principal residence. If YES, please indicate the date of occupancy MO DAY YEAR or intended occupancy. 3$57  75$16)(5 ,1)250$7,21 Please complete all statements. YES NO A. This transfer is solely between spouses (addition or removal of a spouse, death of a spouse, divorce settlement, etc.). B. This transfer is solely between domestic partners currently registered with the California Secretary of State (addition or removal of a partner, death of a partner, termination settlement, etc.). C. This is a transfer between: parent(s) and child(ren) grandparent(s) and grandchild(ren). * * D. This transaction is to replace a principal residence by a person 55 years of age or older. Within the same county? YES NO * E. This transaction is to replace a principal residence by a person who is severely disabled as defined by Revenue and Taxation Code section 69.5. Within the same county? YES NO F. 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). If YES, please explain: G. The recorded document creates, terminates, or reconveys a lender's interest in the property. H. This transaction is recorded only as a requirement for financing purposes or to create, terminate, or reconvey a security interest (e.g., cosigner). If YES, please explain: : I. The recorded document substitutes a trustee of a trust, mortgage, or other similar document. J. This is a transfer of property: 1. to/from a revocable trust that may be revoked by the transferor and is for the benefit of registered domestic partner. the transferor, and/or the transferor's spouse 2. to/from a trust that may be revoked by the creator/grantor/trustor who is also a joint tenant, and which names the other joint tenant(s) as beneficiaries when the creator/grantor/trustor dies. 3. to/from an irrevocable trust for the benefit of the creator/grantor/trustor and/or grantor's/trustor’s spouse grantor’s/trustor’s registered domestic partner. 4. to/from an irrevocable trust from which the property reverts to the creator/grantor/trustor within 12 years. K. This property is subject to a lease with a remaining lease term of 35 years or more including written options. L. This is a transfer between parties in which proportional interests of the transferor(s) and transferee(s) in each and every parcel being transferred remain exactly the same after the transfer. M. This is a transfer subject to subsidized low-income housing requirements with governmentally imposed restrictions. * N. This transfer is to the first purchaser of a new building containing an active solar energy system. * If you checked YES to statements C, D, or E, you may qualify for a property tax reassessment exclusion, which may allow you to maintain your previous tax base. If you checked YES to statement N, you may qualify for a property tax new construction exclusion. A claim form must be filed and all requirements met in order to obtain any of these exclusions. Contact the Assessor for claim forms. 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 BOE-502-AH (P2) REV. 13 (07-10) 3$57  27+(5 75$16)(5 ,1)250$7,21 Check and complete as applicable. A. Date of transfer, if other than recording date: B. Type of transfer: Purchase Foreclosure Gift Trade or exchange Merger, stock, or partnership acquisition (Form BOE-100-B) Contract of sale. Date of contract: Sale/leaseback Inheritance. Date of death: Creation of a lease Assignment of a lease Termination of a lease. Date lease began: Remaining term in years (including written options): Original term in years (including written options): Other. Please explain: C. Only a partial interest in the property was transferred. YES NO PART 3. PURCHASE PRICE AND TERMS OF SALE Check and complete as applicable. A. Total purchase or acquisition price. Do not include closing costs or mortgage insurance. Down payment: Interest rate: $ % If YES, indicate the percentage transferred: $ Seller-paid points or closing costs: $ % Balloon payment: $ Assumption of Contractual Assessment* with a remaining balance of: $ * An assessment used to finance property-specific improvements that constitutes a lien against the real property. Loan carried by seller B. The property was purchased: Direct from seller Through real estate broker. Broker name: Phone number: ( ) From a family member Other. Please explain: C. Please explain any special terms, seller concessions, financing, and any other information (e.g., buyer assumed the existing loan balance) that would assist the Assessor in the valuation of your property. 3$57  3523(57< ,1)250$7,21 Check and complete as applicable. A. Type of property transferred Single-family residence C. Manufactured home Condominium Unimproved lot Other. Description: (i.e., timber, mineral, water rights, etc.) B. Co-op/Own-your-own Multiple-family residence. Number of units: Timeshare Commercial/Industrial NO Personal/business property, or incentives, are included in the purchase price. Examples are furniture, farm equipment, machinery, club memberships, etc. Attach list if available. If YES, enter the value of the personal/business property: $ YES YES NO A manufactured home is included in the purchase price. If YES, enter the value attributed to the manufactured home: $ YES D. NO The manufactured home is subject to local property tax. If NO, enter decal number: YES NO The property produces rental or other income. If YES, the income is from: Lease/rent Contract E. The condition of the property at the time of sale was: Good Mineral rights Average Other: Fair Poor CERTIFICATION I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing and all information hereon, including any accompanying statements or documents, is true and correct to the best of my knowledge and belief. This declaration is binding on each and every buyer/transferee. SIGNATURE OF BUYER/TRANSFEREE OR CORPORATE OFFICER DATE NAME OF BUYER/TRANSFEREE/LEGAL REPRESENTATIVE/CORPORATE OFFICER (PLEASE PRINT) TITLE E-MAIL ADDRESS The Assessor’s office may contact you for additional information regarding this transaction. American LegalNet, Inc. www.FormsWorkFlow.com