BOE-58-G (P1) REV. 15 (05-16) CLAIM FOR REASSESSMENT EXCLUSION FOR TRANSFER FROM GRANDPARENT TO GRANDCHILD Please return form to: JOHN TUTEUR NAPA COUNTY ASSESSOR 1127 FIRST ST RM 128 NAPA CA 94559 Contact our office at 707-253-4464 or via email at: assessor@countyofnapa.org NAME AND MAILING ADDRESS (Make necessary corrections to the printed name and mailing address.) A. PROPERTY ASSESSOR'S PARCEL NUMBER DATE OF PURCHASE OR TRANSFER DATE OF DEATH OF GRANDPARENT (if applicable) PROPERTY ADDRESS RECORDER'S DOCUMENT NUMBER PROBATE NUMBER (if applicable) 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. B. TRANSFEROR(S)/SELLER(S) (GRANDPARENTS) 1. Print full name(s) of transferor(s) 2. Was this property the principal residence of the transferor? Homeowners' Exemption Disabled Veterans' Exemption Yes No If yes, please check which one of the following exemptions was granted or was eligible to be granted on this property: 3. Was real property other than the principal residence of the transferor transferred? 4. Was only a partial interest in the property transferred? 5. Did you own this property as a joint tenant? Yes Yes No No Yes No If yes, percentage transferred _______%. 6. If the transfer was through the medium of a will and/or trust, you must attach a full and complete copy of the will and/or trust and all amendments. 7. 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. t t SIGNATURE OF TRANSFEROR OR LEGAL REPRESENTATIVE PRINTED NAME SIGNATURE OF TRANSFEROR OR LEGAL REPRESENTATIVE PRINTED NAME MAILING ADDRESS CITY, STATE, ZIP DATE DATE DAYTIME PHONE NUMBER EMAIL ADDRESS ( ) THIS DOCUMENT IS NOT SUBJECT TO PUBLIC INSPECTION 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 Adopted by whom? 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: 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? Yes No b. Is the spouse or registered domestic partner of the deceased parent a (check one): Parent of the grandchild (go to question c). Stepparent of the grandchild (a stepparent to the grandchild need not be deceased in meeting the condition that "all of the parents" of the grandchild must be deceased) (go to question 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 purchase or transfer to qualify for exclusion. Date of marriage/partnership registration: (Please provide marriage or partnership certificate.) If no, surviving spouse/partner is still considered a child of grandparents and must also be deceased prior to the purchase or transfer to qualify for exclusion. Date of death (Please provide death certificate.) 3. Did transferee receive a principal residence from parents? (If transferee has already received an excludable principal residence, or interest therein, from parents, then the purchase or transfer of a principal residence from grandparents will not be excluded as a principal residence but will be applied toward the one million dollar ($1,000,000) full cash value limit exclusion of other real property received from parents.) Yes No If yes: County: Assessor's Parcel Number: 4. Did transferee receive real property other than a principal residence from deceased parent who is a direct descendent of grandparents? (If transferee has already received an excludable principal residence, or interest therein, from parents, then the purchase or transfer of a principal residence from grandparents will not be excluded as a principal residence but will be applied toward the one million dollar ($1,000,000) full cash value limit exclusion of other real property received from deceased parents.) Yes No If yes, attach list of all previous transfers (include for each property: the county, Assessor's parcel number, situs address, date of transfer, names of all transferees, and the family relationship). Note: The Assessor may require additional legal documentation to support the above answers. ADDITIONAL TRANSFEREE(S)/BUYER(S) (GRANDCHILD) (continued) NAME RELATIONSHIP 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 grandchild (or their legal representative) of the transferors listed in Section B. I certify that all my parents who qualify as children of my transferor grandparents are deceased as of the date of transfer or purchase, and that all of the transferees are eligible transferees within the meaning of section 63.1 of the Revenue and Taxation Code. t SIGNATURE OF TRANSFEREE OR LEGAL REPRESENTATIVE MAILING ADDRESS CITY, STATE, ZIP DATE DAYTIME PHONE NUMBER EMAIL ADDRESS ( ) American LegalNet, Inc. www.FormsWorkFlow.com BOE-58-G (P3) REV. 15 (05-16) CLAIM FOR REASSESSMENT EXCLUSION FOR TRANSFER BETWEEN GRA