PHIL TING OFFICE F THE ASSESSOR-RECORDER O SAN FRANCISCO ASSESSOR-RECORDER P T - ~ ~ - F R o ~ (REVISED 3-1 6-94) 52-91 CLAIM FOR NEW COlJSTRUCTlON EXCLUSION FRoM'SUPPLEMENTAL ASSESSMENT THIS FORM MUST BE FILED WT THE ASSESSOR PRIOR TO ORWITHIN 30 IH DAYS OF M E START OF CONSTRUCTION NAME STREET C FOR ASSESSOR'S o N i Y USE Received Approved Denied Reason for denial Parcel No. Address of dwelling 1.w STATE AND ZIP CODE STATEMENT I own the property described above, I have commenced/or wilt commence construction on the property on , and therefore claim the construction exclusion from supplemental assessment provided by Section 75.12 of the California Revenue and Taxation Code. (Assessor must be notified within 30 days of the start of construction.) I currently offer, or intend to offer, the property for sale dr other change of owneiship arid do not iriterid to rent, .lease, occupy, or otherwise use the property, except as model homesor other use as is incidental to an offer for a change of ownership. I undeistand that this exclusion shall apply only to the supplemental assessment regarding new construction on this property and shall not preclude the reassessmeiit of any such property on the assessment roll for the January 1 following the date of completion of construction, or to any other supplemental assessments on this property. I certify (or declare) undqpenalw of pejury under the laws of the State of California that the foregoing statements are true and correct. Signature of Ownei (required) Date Daytime Phone Number Only the owner dr a co-owner of the above-described property (including a purchaser under contract.of sale) or his legal representative riray sign. I f you are buying this property under any linrecorded contract of sale and the assessor does not have a copy of the contidt, you must attach a copy of the claim. City Hall Office:1 Dr. Cadton B. Goodlett Place Room 190. San Francisco. CA 941024698 Tel: (415) 554-5516 Fax: (415) 554-7915 www.sfgov.org/assessor e-mail: assessor@sfgov.org Business Personal Property: 875 Stevenson Street Room 100, San Francisco. CA 94103 Tel: (4 15) 554-553 1 Fax: (4 15) 554-5544 American LegalNet, Inc. www.FormsWorkflow.com