EF-58-AH-R16-0514-36000295-1 BOE-58-AH (P1) REV. 16 (05-14) Bob Dutton Assessor-Recorder-County Clerk County of San Bernardino Assessor's Office 172 West Third Street San Bernardino, CA 92415-0310 www.sbcounty.gov/assessor (909) 387-8307 - 1-877-885-7654 CLAIM FOR REASSESSMENT EXCLUSION FOR TRANSFER BETWEEN PARENT AND CHILD NAME AND MAILING ADDRESS (Make necessary corrections to the printed name and mailing address.) A. PROPERTY ASSESSOR'S PARCEL NUMBER PROPERTY ADDRESS CITY RECORDER'S DOCUMENT NUMBER DATE OF PURCHASE OR TRANSFER PROBATE NUMBER (if applicable) DATE OF DEATH (if applicable) DATE OF DECREE OF DISTRIBUTION (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) (additional transferors please complete "B" on the reverse) 1. Print full name(s) of transferor(s) 2. Social security number(s) 3. Family relationship(s) to transferee(s) If adopted, age at time of adoption 4. Was this property the transferor's principal residence? Yes No If yes, please check which of the following exemptions was granted or was eligible to be granted on this property: Homeowners' Exemption Disabled Veterans' Exemption Yes No 5. Havetherebeenother sthatqualifiedforthisexclusion? If yes,pleaseattachalistofallprevioustransfersthatqualifiedforthisexclusion.(Thislistshouldincludeforeachproperty:theCounty, Assessor's parcel number, address, date of transfer, names of all the transferees/buyers, and family relationship. Transferor's principal residencemustbeidentified.) Yes No If yes, percentage transferred % 6. Was only a partial interest in the property transferred? 7. Was this property owned in joint tenancy? Yes No 8. If the transfer was through the medium of a trust, you must attach a copy of the trust. 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 and correct to the best of my knowledge and that I am the parent or child (or transferor's 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 DATE DATE SIGNATURE OF TRANSFEROR OR LEGAL REPRESENTATIVE MAILING ADDRESS CITY, STATE, ZIP t t DAYTIME PHONE NUMBER ( ) EMAIL ADDRESS (Please complete applicable information on reverse side.) THIS DOCUMENT IS NOT SUBJECT TO PUBLIC INSPECTION American LegalNet, Inc. www.FormsWorkFlow.com EF-58-AH-R16-0514-36000295-2 BOE-58-AH (P2) REV. 16 (05-14) C. TRANSFEREE(S) / BUYER(S) (additional transferees please complete "C" below) 1. Print full name(s) of transferee(s) 2. Family relationship(s) to transferor(s) If adopted, age at time of adoption If stepparent/stepchild relationship is involved, was parent still married to or in a registered domestic partnership (registered means registered with the California Secretary of State) with stepparent on the date of purchase or transfer? Yes No If no, was the marriage or registered domestic partnership terminated by: Death Divorce/Termination of partnership If terminated by death, had the surviving stepparent remarried or entered into a registered domestic partnership as of the date of purchase Yes No or transfer? If in-law relationship is involved, was the son-in-law or daughter-in-law still married to or in a registered domestic partnership with the Yes No daughter or son on the date of purchase or transfer? If no, was the marriage or registered domestic partnership terminated by: Death Divorce/Termination of partnership If terminated by death, had the surviving son-in-law or daughter-in-law remarried or entered into a registered domestic partnership as of Yes No the date of purchase or transfer? 3. ALLOCATION OF ExCLUSION (If the full cash value of the real property transferred exceeds the one million dollar value exclusion, the transferee must specify on an attachment to this claim the amount and allocation of the exclusion that is being sought.) 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 and correct to the best of my knowledge and that I am the parent or child (or transferee's legal representative) of the transferors listed in Section B; and that all of the transferees are eligible transferees within the meaning of section 63.1 of the Revenue and Taxation Code. SIGNATURE OF TRANSFEREE OR LEGAL REPRESENTATIVE DATE SIGNATURE OF TRANSFEREE OR LEGAL REPRESENTATIVE MAILING ADDRESS CITY, STATE, ZIP Note: The Assessor may contact you for additional information. B. ADDITIONAL TRANSFEROR(S) / SELLER(S) (continued) t t DATE DAYTIME PHONE NUMBER EMAIL ADDRESS ( ) NAME SOCIAL SECURITY NUMBER SIGNATURE RELATIONSHIP C. ADDITIONAL TRANSFEREE(S) / BUYER(S) (continued) NAME RELATIONSHIP American LegalNet, Inc. www.FormsWorkFlow.com EF-58-AH-R16-0514-36000295-3 BOE-58-AH (P3) REV. 16 (05-14) CLAIM FOR REASSESSMENT EXCLUSION FOR TRANSFER BETWEEN PARENT AND CHILD Revenue and Taxation Code, Section 63.1 IMPORTANT: In order to qualify for this exclusion, a claim form must be completed and signed by the transferors and a transferee and filed with the 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 notice of supplemental or escape assessment for this property. If a claim is not timely filed, the exclusion will be granted beginning with the calendar year in which you file your claim. Complete all of Sections A, B, and C and answer each question or yo