BOE-58-G (P1) REV. 15 (05-16) _____________________________, ASSESSOR ________________________________________ ________________________________________ TELEPHONE: _____________________________ CLAIM FOR REASSESSMENT EXCLUSION FOR TRANSFER FROM GRANDPARENT TO GRANDCHILD NAME AND MAILING ADDRESS (Make necessary corrections to the printed name and mailing address.) FOR OFFICE USE ONLY DATE RECORDED PRINCIPAL RESIDENCE APPROVED DENIED SV83 OTHER SV84 IMPORTANT: In or der t o qual ify for t his exclusion, a claim f orm must be completed and s igned by t he t ransferors and a transferee and f iled with t he 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 no tice of supplemental or escape assessment for this property. I f a claim is not timely filed, the exclusion will be gr anted beginning with t he c alendar y ear in which y ou f ile y our c laim. C omplete al l of s ections A, B, and C and ans wer eac h ques tion or y our c laim 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 that claim with any revised information. Please note: 1. 2. 3. 4. 5. This exclusion only applies to transfers that occur on or after March 27, 1996. In or der t o qual ify, al l t he par ents of t hat gr andchild must be dec eased as of t he dat e of pur chase or t ransfer. A s us ed i n t he preceding sentence, parents are those persons who qualify under Section 63.1 as children of the grandparents. H owever, for transfers that occur on or after January 1, 2006 a s on-in-law or daught er-in-law of t he gr andparent t hat i s a step-parent to the gr andchild need no t be de ceased i n meeting the condition that "all of the parents" of the grandchild must be deceased. In order to qualify, the real property must be transferred from grandparents to their grandchildren. If you do not complete and return this form, it may result in this property being reassessed. 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 certain grandparent and grandchild transfers (see above); and/or · The first $1,000,000 of the factored base year value of other real property between parents and children and certain grandparents and grandchild transfers (see above). PROPERTY ADDRESS RECORDER'S DOCUMENT NUMBER PROBATE NUMBER (if applicable) A. PROPERTY ASSESSOR'S PARCEL NUMBER DATE OF PURCHASE OR TRANSFER DATE OF DEATH OF GRANDPARENT (if applicable) B. TRANSFEROR(S)/SELLER(S) (GRANDPARENTS) 1. 2. 3. 4. 5. 6. 7. Print full name(s) of transferor(s) Was this property the principal residence of the transferor? Yes No If yes, please check which one of the following exemptions was granted or was eligible to be granted on the property: Homeowners' Exemption Disabled Veterans' Exemption Was real property other than the principal residence of the transferor transferred? Yes No Was only a partial interest in the property transferred? Yes No If yes, percentage transferred ________%. Did you own this property as a joint tenant? Yes No If the transfer was through the medium of will and/or trust, you must attach a full and complete copy of the will and/or trust and all amendments. Print name(s) of child(ren) of transferor(s)/seller(s) who is (are) the parent(s) of transferee(s) (grandchild): CERTIFICATION I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing and any accompanying statements are true and correct to the best of my knowledge and that I am the grandparent (or their legal representative) of the transferees listed in Section C. I knowingly am granting this exclusion and will not file a claim to transfer the base year value of my principal residence under Revenue and Taxation Code section 69.5. SIGNATURE OF TRANSFEROR OR LEGAL REPRESENTATIVE PRINTED NAME PRINTED NAME DATE DATE DAYTIME PHONE NUMBER SIGNATURE OF TRANSFEROR OR LEGAL REPRESENTATIVE MAILING ADDRESS CITY, STATE, ZIP ( THIS DOCUMENT IS NOT SUBJECT TO PUBLIC INSPECTION ) EMAIL ADDRESS American LegalNet, Inc. www.FormsWorkFlow.com BOE-58-G (P2) REV. 15 (05-16) C. TRANSFEREE(S)/BUYER(S) (GRANDCHILD) (additional transferees please complete "C" below) 1. Print full name(s) of transferee(s) Family relationship(s) to transferor(s) If adopted, age at time of adoption 2. Parent: Name of direct descendent of grandparent (son or daughter) Date of death of direct descendent: ________________________________________________________________________________________ (Direct descendent must be deceased in order to qualify for this exclusion. Please provide death certificate.) Social Security Number of direct descendent: ___________ - ____________ - ____________ The disclosure of social security numbers is mandatory as required by Revenue and Taxation Code section 63.1. [See Title 42 United States Code, section 405(c)(2)(C)(i) which authorizes the use of social security numbers for identification purposes in the administration of any tax.] A foreign national who cannot obtain a social security number may provide a tax identification number issued by the Internal Revenue Service. The numbers are used by the Assessor and the state to monitor the exclusion limit. a. Was deceased parent married or in a registered domestic partnership (registered means registered with the California Secretary of State) as of the date of death? b. Yes No Is the spouse or registered domestic partner of the deceased parent a (check one): Parent of the grandchild (go to question c). Step-parent of the grandchild (a step-parent to the grandchild need not be deceased in meeting the condition that "all of the parents" of the grandchild must be deceased) (go to item no. 3). c. Had surviving spouse/partner remarried or entered into a registered domestic partnership as of the date of purchase or transfer. Yes No If yes, date of marriage or registration of the domestic partnership must have occurred prior to the date of purcha