BOE-502-AH (P1) REV. 15 (05-13) CHANGE IN OWNERSHIP STATEMENT This statement represents a written request from the Assessor. Failure to file will result in the assessment of a penalty. FILE THIS STATEMENT BY: Carmen Chu, Assessor-Recorder Office of the Assessor-Recorder City and County of San Francisco 1 Dr. Carlton B. Goodlett Place, Room 190 San Francisco, CA 94102 www.sfassessor.org (415) 554-5596 NAME AND MAILING ADDRESS OF BUYER/TRANSFEREE (Make necessary corrections to the printed name and mailing address) ASSESSOR'S PARCEL NUMBER SELLER/TRANSFEROR BUYER'S DAYTIME TELEPHONE NUMBER ( STREET ADDRESS OR PHYSICAL LOCATION OF REAL PROPERTY MAIL PROPERTY TAX INFORMATION TO (NAME) ADDRESS ) BUYER'S EMAIL ADDRESS CITY MO STATE ZIP CODE DAY YEAR YES NO This property is intended as my principal residence. If YES, please indicate the date of occupancy or intended occupancy. PART 1. TRANSFER INFORMATION YES NO Please complete all statements. This section contains possible exclusions from reassessment for certain types of transfers. A. This transfer is solely between spouses (addition or removal of a spouse, death of a spouse, divorce settlement, etc.). B. This transfer is solely between domestic partners currently registered with the California Secretary of State (addition or removal of a partner, death of a partner, termination settlement, etc.). from grandparent(s) to grandchild(ren). * C. This is a transfer: between parent(s) and child(ren) * D. This transfer is the result of a cotenant's death. Date of death ____________________________ * E. This transaction is to replace a principal residence by a person 55 years of age or older. Within the same county? YES NO * F. This transaction is 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 G. This transaction is only a correction of the name(s) of the person(s) holding title to the property (e.g., a name change upon marriage). If YES, please explain: H. The recorded document creates, terminates, or reconveys a lender's interest in the property. I. This transaction is recorded only as a requirement for financing purposes or to create, terminate, or reconvey a security interest (e.g., cosigner). If YES, please explain: J. The recorded document substitutes a trustee of a trust, mortgage, or other similar document. K. This is a transfer of property: 1. to/from a revocable trust that may be revoked by the transferor and is for the benefit of the transferor, and/or the transferor's spouse registered domestic partner. 2. to/from a trust that may be revoked by the creator/grantor/trustor who is also a joint tenant, and which names the other joint tenant(s) as beneficiaries when the creator/grantor/trustor dies. 3. to/from an irrevocable trust for the benefit of the creator/grantor/trustor and/or grantor's/trustor's spouse grantor's/trustor's registered domestic partner. L. This property is subject to a lease with a remaining lease term of 35 years or more including written options. M. This is a transfer between parties in which proportional interests of the transferor(s) and transferee(s) in each and every parcel being transferred remain exactly the same after the transfer. N. This is a transfer subject to subsidized low-income housing requirements with governmentally imposed restrictions. * O. This transfer is to the first purchaser of a new building containing an active solar energy system. * Please refer to the instructions for Part 1. Please provide any other information that will help the Assessor understand the nature of the transfer. THIS DOCUMENT IS NOT SUBJECT TO PUBLIC INSPECTION American LegalNet, Inc. www.FormsWorkFlow.com BOE-502-AH (P2) REV. 15 (05-13) PART 2. OTHER TRANSFER INFORMATION A. Date of transfer, if other than recording date: B. Type of transfer: Purchase Sale/leaseback Foreclosure Gift Trade or exchange Assignment of a lease Check and complete as applicable. Merger, stock, or partnership acquisition (Form BOE-100-B) Inheritance. Date of death: Termination of a lease. Date lease began: Remaining term in years (including written options): If YES, indicate the percentage transferred: % $_______________ Amount $_______________ Amount $_______________ Variable rate Contract of sale. Date of contract: Creation of a lease Original term in years (including written options): Other. Please explain: C. Only a partial interest in the property was transferred. A. Total purchase price YES NO PART 3. PURCHASE PRICE AND TERMS OF SALE Check and complete as applicable. B. Cash down payment or value of trade or exchange excluding closing costs C. First deed of trust @ ______% interest for ______ years. Monthly payment $_____________ FHA (____Discount Points) Cal-Vet VA (____Discount Points) Loan carried by seller Fixed rate Bank/Savings & Loan/Credit Union Balloon payment $_____________ Fixed rate Variable rate Due date: _____________ D. Second deed of trust @ ______% interest for ______ years. Monthly payment $_____________ Bank/Savings & Loan/Credit Union Due date: _____________ YES NO Loan carried by seller Balloon payment $_____________ Amount $_______________ E. Was an Improvement Bond or other public financing assumed by the buyer? G. The property was purchased: Direct from seller Other. Please explain: Through real estate broker. Broker name: Outstanding balance $_______________ Phone number: F. Amount, if any, of real estate commission fees paid by the buyer which are not included in the purchase price From a family member-Relationship______________________ ( $_______________ ) H. Please explain any special terms, seller concessions, broker/agent fees waived, financing, and any other information (e.g., buyer assumed the existing loan balance) that would assist the Assessor in the valuation of your property. PART 4. PROPERTY INFORMATION A. Type of property transferred Single-family residence Multiple-family residence. Number of units: Other. Description: (i.e., timber, mineral, water rights, etc.) B. YES Check and complete as applicable. Co-op/Own-your-own Condominium Timeshare Manufactured home Unimproved lot Commercial/Industrial NO Personal/business property, or incentives, provided by seller to buyer are included in the purchase price. Examples of personal property are furniture, farm equipment, machinery, etc. Examples of incentives are club memberships, etc. Attach list if available. Incentives $ If YES, enter the valu