COUNTY OF LOS ANGELES · JEFFREY PRANG, ASSESSOR · OWNERSHIP SERVICES 500 WEST TEMPLE STREET, ROOM 205 · LOS ANGELES, CA 90012 · (213) 974-3441 REGION CLUSTER ASSESSOR'S IDENTIFICATION NUMBER PROPERTY OWNER'S DECLARATION MAPBOOK PAGE PARCEL INSTRUCTIONS - Completion of this form is required before a reversal of the reappraisal of your property can be processed. Complete sections 1 through 4 and attach copies of all pertinent documents. The attachment of supporting documentation is required and shall include, but not be limited to; cancelled checks, tax returns, copies of written agreements notarized at the time of execution, judicial findings or orders, certificates of marriage or death and copies of deeds or trusts. Sign and date the declaration on the reverse and return this form to the address shown above. For information, call the number shown above. 1. GENERAL INFORMATION NAME OF PROPERTY OWNER OR AGENT SITUS ADDRESS/PROPERTY LOCATION CITY STATE ZIP CODE 2. TRANSACTION INFORMATION - List the titles, numbers and recording dates of the documents involved in the transaction(s) which led to the current situation. DOCUMENT TITLE DOCUMENT NUMBER RECORDING DATE 1 2 3 List additional documents in Remarks Check the boxes which best describe your situation. A. FINANCIAL TRANSACTION The vestee removed from title had no beneficial interest in the property and was on title solely as co-signer for the loan. Provide the signatures of all persons party to the transaction and indicate the method of holding title, such as joint tenancy, tenancy-in-common, etc. SIGNATURE GRANTEE GRANTOR GRANTEE GRANTOR GRANTEE GRANTOR GRANTEE GRANTOR OTHER: OTHER: METHOD B. PERFECTION OF TITLE Change in method of holding title (CC§682) Disclaimer (PC§190) Name change (CC§1096) Involuntary trust (CC§§2223-2224) Resulting trust (CC§853) Adverse claim (PC§851.5) Provide the signatures of all persons party to the transaction and indicate the method of holding title, such as joint tenancy, tenancy-in-common, etc. SIGNATURE GRANTEE GRANTOR GRANTEE GRANTOR GRANTEE GRANTOR GRANTEE GRANTOR METHOD C. Trust INTERSPOUSAL TRANSFER D. Grantors are among the grantees (R&TC §62(f)) Excluded transfer back to original transferor (R&TC §65) Excluded transfer to all remaining joint tenants Other: JOINT TENANCY E. Revocable trust Short term trust Trustor or spouse is beneficiary Transfer back to trustor where transfer to trust was excluded Substitution of trustee TRUST Death, joint tenant Distribution by will or intestate succession Property settlement agreement, dissolution, legal separation. Date: F. LAND CONTRACT Assignment of vendor's interest Termination of vendor's interest Change valuation date to date of origin of land contract Date: G. LIFE ESTATE Reservation of life estate by grantor or spouse Other: H. LEGAL ENTITIES *Transfer between affiliated entities Transfer to or from legal entity-proportional ownership interest remains the same (R&TC §62(a)) *The taxpayer shall furnish proof, under penalty of perjury, to the Assessor that the transfer meets the requirements of this subdivision. (R&TC §64(b)) American LegalNet, Inc. www.FormsWorkFlow.com OWN-48 (FRONT) (REV. 1/15) I. J. K. L. M. Transfer Between Co-Owners Parent-Child Transfer (Prop.58) Grandparent - Grandchild (Prop. 193) Senior Citizen Transfer (Prop. 60) Claimant 55 years or older Eminent Domain/Condemnation (Prop. 3) Displacement by government agencies N. Other Situation (please specify) 3. REMARKS - State the problem and your intentions upon entering into this transaction. Outline the sequence of events which led to the current situation and provide the names of all persons involved. Attach additional pages if needed. The Assessor can audit this statement for completeness and accuracy and will contact you as required. False statements willfully made will subject declarant to Civil and/or Penal penalties. Fraudulent underassessments or escapes shall, when discovered, be corrected and added to the current and all five (5) preceding assessment rolls as required. (Revenue and Taxation Code Sections 441, 461, 503, 531, 532,) Penal Code Sections 118, 126). 4. DECLARATION: I declare under penalty of perjury under the laws of the state of California that the foregoing and any accompanying or attached statements, records and/or schedules are true and correct. SIGNATURE OF OWNER OR AGENT STREET ADDRESS OF OWNER OR AGENT* CITY DATE TITLE (If agent) STATE ZIP CODE PHONE (8 a.m.-5 p.m.) *If agent, is Tax Agent Authorization form filled? Yes No OWN-48 (BACK) (REV. 1/15) American LegalNet, Inc. www.FormsWorkFlow.com