TO BE COMPLETED BY THE CLAIMANT (DISABLED PERSON, SPOUSE OR LEGAL GUARDIAN)PRINT NAME OF CLAIMANT PRINT NAME OF DISABLED PERSON (if different)ADDRESS OF PROPERTY WITH NEW CONSTRUCTION ASSESSOR222S PARCEL NUMBER DESCRIBE THE IMPROVEMENTS MADE CLAIMANT222S SIGNATURE DATE CONSTRUCTION COMPLETEDCERTIFICATIONI certify (or declare) under penalty of perjury under the laws of the State of California that the disabled person named above permanently resides at the property address and that the construction was to make the residence more accessible to the disabled person. DAYTIME PHONE NUMBER ( ) DATE E-MAIL ADDRESS TO BE COMPLETED BY PHYSICIANThe claimant named above is applying to have a portion or all of the construction, installation or modi336 cation of a dwelling excluded from reappraisal because it makes the dwelling more accessible to a severely and permanent disabled person. For purposes of this tax bene336 t, the law de336 nes a severely and permanently disabled person as any person who has a physical disability or impairment which affects sight, speech, hearing, or the use of any limbs and which results in a functional limitation as to employment or substantially limits one or more major life activity of that person, and which has been diagnosed as permanently affecting the person222s ability to function.NAME OF DISABLED PERSON (please print) PLEASE IDENTIFY THE SPECIFIC DISABILITY-RELATED REQUIREMENTS NECESSITATING ACCESSIBILITY IMPROVEMENTS OR FEATURES I am a licensed Physician Surgeon My specialty is DECLARATIONI declare that the disabled person named above is severely and permanently disabled according to the de336 nition above and that the construction, installation or modi336 cation makes the dwelling more accessible to that person. PHYSICIAN222S SIGNATURE DATEPHYSICIAN222S NAME (print or type) PHYSICIAN222S PHONE NUMBER( ) BOE-63 (FRONT) REV. (-8) DISABLED PERSONS CLAIM FOREXCLUSION OF NEW CONSTRUCTION This claim is for the exclusion from reassessment of any construction to make an existing dwelling more accessible to a severely and permanently disabled person who is a permanent resident of the dwelling. Only construction completed on or after June 6, 1990 is eligible. The exclusion does not apply to accessibility improvements and features that are usual or customary for comparable properties not occupied by disabled persons. American LegalNet, Inc. www.FormsWorkFlow.com BOE-63 (BACK) REV. (-8)GENERAL INFORMATIONCalifornia law provides that certain construction, installations, or modi336 cations of existing single- or multiple-family dwellings can be excluded from increases in property taxation if the work is performed to make the dwelling more accessible to a severely and permanently disabled person who is a permanent resident of the dwelling. This exclusion does not apply to accessibility improvements and features that are usual or customary for comparable properties not occupied by disabled persons, but will apply only to those improvements or features that speci336 cally adapt a dwelling for accessibility by a severely disabled person.Revenue and Taxation Code section 74.3(b) de336 nes a severely and permanently disabled person as any person who has a physical disability or impairment, whether from birth or by reason of accident or disease, including but not limited to any disability or impairment which affects sight, speech, hearing, or use of any limbs and which results in a functional limitation as to employment or substantially limits one or more major life activity of that person, and which has been diagnosed as permanently affecting the person222s ability to function.To qualify for this exclusion:225The construction, installations, or modi336 cations must be completed on or after June 6, 1990;225The disabled person must be a permanent resident (not necessarily the owner) of the dwelling;and225The dwelling must be occupied by the owner and therefore eligible for the homeowners222exemption.To claim the exclusion, the disabled person, his or her spouse, or legal guardian must submit to the Assessor the following:225A statement signed by a licensed physician or surgeon of appropriate specialty which certi336 es thatthe person is severely and permanently disabled as de336 ned above. The statement must identifyspeci336 c disability-related requirements necessitating accessibility improvements or features, and225A statement that identi336 es the construction, installation, or modi336 cation that was in fact necessaryto make the structure more accessible to the disabled person.The Assessor may charge a fee to the disabled person or his or her spouse or legal guardian suf336 cient to reimburse the Assessor for the costs of processing and administering the statement. American LegalNet, Inc. www.FormsWorkFlow.com