MARK CHURCH
EF-62-LRDP-R00-1118-41000799-1                                                         Assessor - County Clerk - Recorder
BOE-62-LRDP (P1) REV. 00 (11-18)                                                       555 County Center
                                                                                       Redwood City, CA 94063
                                                                                       P 650.363.4500    F 650.599.7435
CLAIM FOR REASSESSMENT REVERSAL FOR                                                    email assessor@smcacre.org
LOCAL REGISTERED DOMESTIC PARTNERS                                                     web www.smcacre.org

A.  Description of the property that was reassessed for a change in ownership:
STREET ADDRESS                                                                                      ASSESSOR’S PARCEL NUMBER
CITY                                               COUNTY                                           RECORDER’S DOCUMENT NUMBER

DATE OF TRANSFER OF INTEREST                                                                        RECORDING DATE

NOTE: Transfers eligible for this exclusion are only those that occurred during the period January 1, 2000 through June 26, 2015.
B.  The parties to the transfer of interest in the above described property:
  TRANSFEROR                                                                  DATE OF DEATH, IF APPLICABLE:

 TRANSFEREE

C.  Date of the creation of the registered domestic partnership: 
 (NOTE: date must be prior to or concurrent with the date of transfer in item B above.)
                 registered
      domestic partners.

                                                   CERTIFICATION
I certify (or declare) 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 was a local registered domestic partner on the date of transfer.
tSIGNATURE OF TRANSFEREE REGISTERED DOMESTIC PARTNER OR LEGAL REPRESENTATIVE                                       DATE

PRINTED NAME OF TRANSFEREE OR LEGAL REPRESENTATIVE                                                  TITLE

 MAILING ADDRESS 

 DAYTIME PHONE NUMBER             EMAIL ADDRESS 
 (         )

                        Be sure to attach a copy of the local registered domestic partnership document. 
                                 Your claim will not be processed without that certificate.
                                 Claim must be filed with the county assessor by June 30, 2022.

                                 THIS DOCUMENT IS SUBJECT TO PUBLIC INSPECTION

EF-62-LRDP-R00-1118-41000799-2
BOE-62-LRDP (P2) REV. 00 (11-18)

                                      REVENUE AND TAXATION CODE SECTION 62(q)

Change in ownership shall not include: (q) (1) Any transfer of property occurring on or after January 1, 2000, to June 26, 2015, inclusive, between
local registered domestic partners, including, but not limited to:

(A)T
    deceased transferor, or by a trustee of such a trust to the local registered domestic partner of the trustor.

(B)T.

(C) Transfers to a local registered domestic partner or former local registered domestic partner in connection with a property settlement
    agreement or decree of dissolution of a local registered domestic partnership or legal separation.

(D)The creation, transfer, or termination, solely between local registered domestic partners, of any co-owner’s interest.

(E)The distribution of a legal entity’s property to a local registered domestic partner or former local registered domestic partner in exchange
    for the interest of the local registered domestic partner in the legal entity in connection with a property settlement agreement or a decree
    of dissolution of a local registered domestic partnership or legal separation.

(2) Any transferee whose property was reassessed in contravention of this subdivision shall obtain a reversal of that reassessment upon             
    application to the county assessor of the county in which the property is located. Application by the transferee shall be 
    made to the assessor no later than June 30, 2022. A county may charge a fee for its costs related to the application and 
    reassessment reversal in an amount that does not exceed the actual costs incurred. This paragraph shall be liberally construed 
    to provide the benefits of this subdivision and Article XIII A of the California Constitution to local registered domestic partners.

Under section 62(q)(2)(E), any reassessment reversal granted pursuant to a claim shall apply commencing with the lien date of the assessment 

Section62(q)(3)definesa“localregistereddomesticpartner”asaregistereddomesticpartnershipestablishedbyacity,county,cityand
or special district in which both of the following conditions are met:

    (A) The registrants were of the same sex at the time of registration.
    (B) The registrants were not in a registered domestic partnership with, or married to, any other person at the time of the transfer.

                                  THIS DOCUMENT IS SUBJECT TO PUBLIC INSPECTION