Sacramento County Office of the Assessor Kathleen Kelleher, Assessor Christina Manley, Assistant Assessor Real Property Division 3701 Power Inn Road, Suite 3000 Sacramento, CA 95826-4329 www.assessor.saccounty.net (916) 875-0700 ADDENDA TO CHANGE IN OWNERSHIP REPORT Business Name Mailing Address Parcel Number Date Physical Location in Sacramento County The Office of the Assessor has received your Preliminary Change of Ownership Report and requests additional information on your income producing property. This request is made in accordance with Section 441-D of the Revenue and Taxation Code, which reads in part: "At any time, as required by the Assessor for assessing purposes, every person shall make available for examination information or records regarding his property." COMPLETE AND RETURN WITHIN 20 DAYS Condition of property at time of transfer New Good Average Poor (Explain "Poor" in remarks section on reverse) Estimated cost of urgent structural repairs and/or renovation: __________________________________________________________ Was the property purchased from a friend or relative? Did a real estate broker represent the seller? Yes Yes No No Name of Broker ______________________________________________________________________________________________ Broker Contact Information (Phone, Email) ____________________________________________________________________ What, in your opinion, is the current market value of this property? ______________________________________________________ Have you listed or offered this property for sale since its purchase? Yes No Asking price: __________________________ Date: ____________________________ COMPLETE SECTION "A" FOR COMMERCIAL/INDUSTRIAL TENANCIES &/OR SECTION "B" IF MULTI-RESIDENTIAL OR MIXED-USE A: RENT ROLL / SCHEDULE FOR COMMERCIAL/INDUSTRIAL ONLY Please complete the following Rent Schedule or attach a copy of your current rent schedule. Indicate vacancies under "NAME OF TENANT" and provide square footage. Indicate in the remarks section on reverse if rent includes personal property, fixtures, or equipment. If rent is a percentage of gross sales or income, indicate which and provide the percentage in the "RENT AS A %" column. MO. & YR. OF LEASE TAX CLAUSE BASE YR EXPENSES PAID BY TENANT ( CHECK ) MAINT R.E. TAXES INSUR UTIL EXT INT NAME OF TENANT SQ. FT. OF UNIT From To MONTHLY RENT RENT AS A % What was your anticipated stabilized vacancy at time of purchase? __________% (Report expenses in Section "C" on the reverse side) What is your standard allowance for tenant improvements ($ Per SF -- amount or range)? __________________________________________ REMARKS SECTION ON REVERSE PLEASE SIGN AND DATE BACK OF STATEMENT [Mass Mail] _ > Change in Ownership Addenda (11/13/2015) American LegalNet, Inc. www.FormsWorkFlow.com OTHER B. RENT ROLL / SCHEDULE FOR MULTI-RESIDENTIAL ONLY PLEASE COMPLETE THE RENT SCHEDULE AS OF THE DATE OF PURCHASE (include owner or manager ­ occupied units) No. UNITS TYPE OF UNIT BEDROOMS BATH ROOMS MO RENT UNF $ FURN $ COMMENTS (Special Features) STATUS OCCUPIED VACANT Have above scheduled rents been increased since your purchase? _____________________%, or proposed __________________% Anticipated Other Income (Laundry, Commercial Space, Vending Machines, etc.) $ # PARKING RENTALS @ $__________ = PARKING TOTAL $ Monthly $__________ Monthly Service & Utilities included in Rent (Indicated by a "" ) Heat_____ Cooling_____ Gas_____ Electricity_____ Water_____ Garbage_____ C. ANNUAL OPERATING EXPENSES (or OPERATING STATEMENT) What were your anticipated annual income and expenses at the time of purchase? Provide prior owner's actuals if available. (For reporting purposes - expenses do not include interest expense, amortization, depreciation, or the urgent repairs and/or renovation listed on the front) See attached copy of actual income & expense statement and/or anticipated income & expense statement; OR Please see itemized income and expenses below. If actual, for what time period? INCOME Gross Scheduled Rents (Potential or Actual) Parking/Other Income (Subject to Vacancy) Vacancy & Collection Loss (Deduction) Effective Gross Income (Collections) Plus Other Income (Laundry, Reimbursements) TOTAL INCOME EXPENSES Management (Prof. Services) Payroll / Onsite Manager / Administrative Marketing / Promotion / Leasing Commissions Utilities Repairs & Maintenance Contracted Services / Janitorial / Elevator Property Taxes Insurance Reserve for Replacements TOTAL EXPENSES NET OPERATING INCOME D. PERSONAL PROPERTY (Indicate the value of any personal property and/or intangibles included in the sales price or the transfer.) Furniture, Equipment and/or Built-in Appliances $ __________________________________________________________________________ Business Enterprise Value / Other Intangibles $ ___________________________________________________________________________ REMARKS: Actual Anticipated Line Item Comments I certify (or declare) 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. Signature of Owner or Lessee Date Daytime Telephone Number Print Name E-mail Address American LegalNet, Inc. www.FormsWorkFlow.com