BOE-502-AH (FRONT) REV. 6 (8-04) CHANGE OF OWNERSHIP STATEMENT REAL PROPERTY OR MANUFACTURED HOMES SUBJECT TO LOCAL PROPERTY TAXES RECORDING DATA SACRAMENTO COUNTY, OFFICE OF THE ASSESSOR KENNETH D. STIEGER, ASSESSOR PROPERTY TRANSFER DIVISION 3701 Power Inn Rd., Ste. 3000, Sacramento, CA 95826-4329 (916) 875-0750 www/saccounty.net/assessor Date Document Number Book File This Statement By Page Correct mailing address if necessary. Assessor’s Parcel Number Name and Address of Buyer/Transferee [last name, first name(s), initial] Property Address Legal Description ( Seller/Transferor ____________________________________________________ ) Phone No. (8 a.m.-5 p.m.) [last name, first name(s) initial] IMPORTANT NOTICE The law requires any transferee acquiring an interest in real property or manufactured home subject to local property taxation, and that is assessed by the Assessor, to file a Change of Ownership Statement with the County Recorder or Assessor. The Change of Ownership Statement must be filed at the time of recording or, if the transfer is not recorded, within 45 days of the date of the change in ownership, except that where the change in ownership has occurred by reason of death the statement shall be filed within 150 days after the date of death or, if the estate is probated, shall be filed at the time the inventory and appraisal is filed. The failure to file a change in ownership statement within 45 days from the date of a written request by the Assessor results in a penalty of either: (1) One hundred dollars ($100), or (2) 10 percent of the taxes applicable to the new base year value reflecting the change in ownership of the real property or manufactured home, whichever is greater, but not to exceed two thousand five hundred dollars ($2,500) if that failure to file was not willful. This penalty will be added to the assessment roll and shall be collected like any other delinquent property taxes, and be subject to the same penalties for nonpayment. This notice is a written request from the Office of the Assessor for a Change of Ownership Statement. If you do not file this statement, it will result in the assessment of a penalty. This statement will be held secret as required by section 481 of the Revenue and Taxation Code. The property which you acquired may be subject to a supplemental assessment in an amount to be determined by the Assessor. For further information on your supplemental roll obligation, please call the at . Assessor PART I: TRANSFER INFORMATION (Please answer all questions.) YES NO A. Is this transfer solely between husband and wife (addition of a spouse, death of a spouse, divorce settlement, etc.)? B. Is this transaction only a correction of the name(s) of the person(s) holding title to the property (e.g., a name change upon marriage)? Please explain: C. Is this document recorded to create, terminate, or reconvey a lender’s interest in the property? D. Is this transaction recorded only as a requirement for financing purposes or to create, terminate, or reconvey a security interest (e.g., cosigner)? Please explain: E. Is this document recorded to substitute a trustee of a trust, mortgage, or other similar document? F. Did this transfer result in the creation of a joint tenancy in which the seller (transferor) remains as one of the joint tenants? G. Does this transfer return property to the person who created the joint tenancy (original transferor)? H. Is this a transfer of property: 1. to a revocable trust that may be revoked by the transferor? 2. to a trust that may be revoked by the Creator/Grantor who is also a joint tenant, and which names the other joint tenant(s) as beneficiaries when the Creator/Grantor dies? 3. to an irrevocable trust for the benefit of the Creator/Grantor and/or Grantor’s spouse? 4. to an irrevocable trust from which the property reverts to the Creator/Grantor within 12 years? I. If this property is subject to a lease, is the remaining lease term 35 years or more including written options? *J. Is this a transfer between parent(s) and child(ren)? Yes No or from grandparent(s) to grandchild(ren)? Yes No *K. Is this transaction to replace a principal residence by a person 55 years of age or older? Within the same county? Yes No *L. Is this transaction 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 M. Did this transfer result from the death of a domestic partner currently registered with the California Secretary of State? * If you answered yes to J, K or L, you may qualify for a property tax reassessment exclusion, which may result in lower taxes on your property. If you do not file a claim, it will result in the reassessment of the property. Please provide any other information that will help the Assessor to understand the nature of the transfer. IF YOU HAVE ANSWERED YES TO ANY OF THE ABOVE QUESTIONS EXCEPT J, K OR L, PLEASE SIGN AND DATE, OTHERWISE COMPLETE THE REVERSE SIDE. American LegalNet, Inc. www.USCourtForms.com BOE-502-AH (BACK) REV. 6 (8-04) PART II: OTHER TRANSFER INFORMATION A. Date of transfer if other than recording date . B. Type of transfer. (Please check appropriate box.) Purchase Foreclosure Gift Trade or exchange Merger, stock, or partnership acquisition Contract of sale – Date of contract Sale/Leaseback Inheritance – Date of death Other: Please explain: Creation of a lease Assignment of a lease Termination of a lease. Date lease began Original term in years (including written options) Remaining term in years (including written options) C. Was only a partial interest in the property transferred? Yes No If yes, indicate the percentage transferred %. PART III: PURCHASE PRICE AND TERMS OF SALE A. CASH DOWN PAYMENT OR VALUE OF TRADE OR EXCHANGE (excluding closing costs) Amount $ B. FIRST DEED OF TRUST @ % interest for years. Pymts./Mo. = $ FHA ( Discount Points) Fixed rate Conventional Variable rate VA ( Discount Points) All inclusive D.T. ($ Wrapped) Cal-Vet Loan carried by seller Balloon payment Yes No Due Date (Prin. & Int. only) Amount $ New loan Assumed existing loan balance Bank or savings & loan Finance company Amount $ C. SECOND DEED OF TRUST @ Bank or savings & loan Loan carried by seller Balloon payment Yes (Prin. & Int. only) Amount $ New loan Assumed existing loan balance Amount $ % interest for Fixed rate Variable rate No years. Pymts./Mo. = $ Due Date D. OTHER FINANCING: Is other financing involved not covered in (b) or (c) above? Yes No Amount $ Type @ % interest for years. Payments/Month = $ (Principal & Interest only) Bank or savings & loan Fixed rate New loan Loan carried by seller Variable rate Assumed existing loan balance Balloon payment Yes No Due Date Amount $ E. WAS AN IMPROVEMENT BOND ASSUMED BY THE BUYER? Yes No Outstanding balance: F. TOTAL PURCHASE PRICE (or acquisition price, if traded or exchanged, include real estate commission if paid) Total Items A through E Amount $ $ G. PROPERTY PURCHASED: Through a broker Direct from seller From a family member Other (explain) . If purchased through a broker, provide broker’s name and phone number: Please explain any special terms, seller concessions, or financing and any other information that would help the Assessor understand the purchase price and terms of sale: PART IV: PROPERTY INFORMATION A. TYPE OF PROPERTY TRANSFERRED: Single-family residence Multiple-family residence (no. of units: Commercial/Industrial Other (Description: i.e., timber, mineral, water rights, etc. Timeshare Manufactured home Unimproved lot ) B. IS THIS PROPERTY INTENDED AS YOUR PRINCIPAL RESIDENCE? If yes, enter date of occupancy / , 20 (month) Agricultural Co-op/Own-your-own Condominium ) Yes (day) No or intended occupancy (month) / (day) , 20 . C. IS PERSONAL PROPERTY INCLUDED IN PURCHASE PRICE (e.g., furniture, farm equipment, machinery, etc.)? (Other than a manufactured home subject to local property tax?) Yes No If yes, enter the value of the personal property included in the purchase price $ (Attach itemized list of personal property.) D. IS A MANUFACTURED HOME INCLUDED IN THE PURCHASE PRICE Yes No If yes, how much of the purchase price is allocated to the manufactured home? $ Is the manufactured home subject to local property tax? Yes No What is the decal number? . E. DOES THE PROPERTY PRODUCE INCOME? Yes No If yes, is the income from: Lease/Rent Contract Mineral rights Other – Explain: F. WHAT WAS THE CONDITION OF THE PROPERTY AT THE TIME OF SALE? Good Average Fair Poor Please explain the physical condition of the property and provide any other information (such as restrictions, etc.) that would assist the Assessor in determining the value of the property: 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, correct, and complete to the best of my knowledge and belief. This declaration is binding on each and every co-owner and/or partner. Signed in County of , California, this SIGNATURE OF OWNER OR CORPORATE OFFICER day of TITLE (if corporate officer/partner) 20 E-MAIL ADDRESS (optional) NAME OF NEW OWNER/LEGAL REPRESENTATIVE/CORPORATE OFFICER (typed or printed) The Assessor’s Office may contact you for additional information regarding this transaction. American LegalNet, Inc. www.USCourtForms.com