MARK CHURCH
EF-265-R11-0518-41000840-1                                                                     Assessor - County Clerk - Recorder
BOE-265 (P1) REV. 11 (05-18)                                                                   555 County Center
                                                                                               Redwood City, CA 94063
CEMETERY EXEMPTION CLAIM                                                                       P 650.363.4500    F 650.599.7435
                                                                                               email assessor@smcacre.org
This claim is filed for fiscal year 20____ - 20____                                            web www.smcacre.org
        NAME AND MAILING ADDRESS
        (Make necessary corrections to the printed name and mailing address)
                                                                                               To receive the full exemption, this claim must 
                                                                                               be filed with the Assessor by February 15.

NAME AND ADDRESS OF OWNER OF LAND AND BUILDINGS (if different from person making claim)

NAME OF ORGANIZATION/CORPORATE NAME FROM ARTICLES (IF INCORPORATED)

ADDRESS OF PROPERTY (CITY, COUNTY, ZIP CODE)                                                          ASSESSOR’S PARCEL NUMBER

OWNER - PROFIT OR NON-PROFIT
 Yes     No  Is the owner organized (or operating) for profit?
 Yes     No  Is the owner incorporated as a non-profit corporation? 
              If yes, enter the dates of incorporation and amendments: _______________________________________________________ 

USE OF PROPERTY
   Check all that apply.
The property is used or held exclusively for the burial or other permanent deposit of the human dead or for the care, maintenance, or upkeep 
of such property or such dead.
The property is not used or held for profit.
EXEMPTION
   Check only one box unless claim covers both inactive and active cemeteries. 
The exemption is claimed for the following described inactive property which constitutes and is used exclusively as a cemetery, no portion of 
which is being leased, rented, or held for sale by the claimant. Enter the Assessor’s parcel number or legal description:  
(If this box is checked and the exemption is not claimed for other properties, Sections A and B need not be completed)
____________________________________________________________________________________________________________
The exemption is claimed for the cemetery properties described on the attached property information section(s).
                  FOR ASSESSOR’S USE ONLY                                                Whom should we contact during normal 
                                                                                         business hours for additional information?
Received by                 (Assessor’s designee)                                 NAME
of 
                             (county or city)                                     ADDRESS (street, city, state, zip code)
on 
                                (date)
Number of Section A in claim 
                                                                                  DAYTIME PHONE NUMBER
                                                                                  (   )
                                                                                  EMAIL ADDRESS

                                                                            CERTIFICATION

I certify (or declare) that the foregoing and all information hereon, including any accompanying statements or documents, is true, correct, and 
                                                  complete to the best of my knowledge and belief.
NAME OF PERSON MAKING CLAIM

SIGNATURE OF PERSON MAKING CLAIM                                            TITLE                                        DATE
t
                                      THIS DOCUMENT IS SUBJECT TO PUBLIC INSPECTION.

EF-265-R11-0518-41000840-2
BOE-265 (P2) REV. 11 (05-18)                                                  Cemetery / Property Name _______________________
SECTION A: INFORMATION CONCERNING THE PROPERTY 
Claimants must complete separate copies of this section for each property for which exemption is sought. Please read instructions before completing.
1: PROPERTY DESCRIPTION
NAME OF ORGANIZATION

ADDRESS OF THIS PROPERTY (street, city, state, zip code)                                          COUNTY

ASSESSOR’S PARCEL NUMBER OR LEGAL DESCRIPTION

Declaration of Dedication.  Date recorded _________________                  Dedication or zoning not required. 
Declaration of Intention.  Date recorded ___________________                  Reason: __________________________________    
Zoning or Cemetery Use Permit.  Date granted _____________                   Total acres of parcel: _____________
2: OWNER AND OPERATOR
Claimant is:                                                                 List the name of any organization which owns or operates 
Owner and Operator                                                           the property other than claimaint: ____________________
Owner only                                                                   ______________________________________________
Operator only of the cemetery and claims exemption on the:                   ______________________________________________
        Land                                                                 ______________________________________________
        Buildings and other improvements                                     ______________________________________________
        Personal property listed herein                                      ______________________________________________
3: LEASED OR RENTED TO OTHERS
 Yes     No  Is any portion of the property described above rented, leased, or being used or operated by some other person or 
             organization?  If yes, describe that portion and its use, and attach a copy of the lease (rental) agreement: ___________
             _______________________________________________________________________________________________
 Yes     No  Is any equipment or other property at this location being leased, rented, or consigned from someone else?  If yes, 
             attach a list that includes the name and address of the owner and the quantity and description of the property.  Property 
             so listed is not subject to the exemption and will be assessed by the Assessor if owned by a taxable entity.
4: LAND USE
Cemetery and related uses:
Number of acres of burial sites in use or offered for sale:      _________   Number of acres of land used for mausoleums:    _________
Number of acres of land used for other building sites,                       Total number of mausoleums:                _________
excluding mausoleums and columbarium:                             _________ 
                                                                             Number of acres of land used for columbarium:    _________
Number of acres of developed roads and parking areas:      _________
                                                                             Total number of columbarium:  
Number o facres for walkways and gardens:                         _________                                             _________
Number of acres of land used for all other cemetery uses:    _________
Noncemetery uses:
Number of acres not developed (unused):                            _________ Total acres of parcel: ____________
Number of acres of land used for other purposes,                             Note: Total must equal the total reported in the property 
including buildings:                                               _________ acreage description.
5: BUILDINGS AND IMPROVEMENTS EXCLUDING MAUSOLEUMS AND COLUMBARIUM SITES
        Building Number or Name                          Principal Use                            Other Use or Uses

6: PERSONAL PROPERTY
                  Description                            Principal Use                            Other Use or Uses

EF-265-R11-0518-41000840-3
BOE-265 (P3) REV. 11 (05-18)
SECTION B: INVENTORY OF UNSOLD BURIAL SITES AND CRYPTS
This section must be completed by profit making organizations. Nonprofit claimants need not answer the following questions. Please read 
instructions before completing.

7: DEVELOPED CEMETERY PLOTS, LAWN CRYPTS, AND LAWN NICHES

                               Total Number              Number Sold                                          Unsold Inventory
        Cemetery Plots
        Lawn Crypts
        Lawn Niches

8: CRYPTS AND NICHES

Do not include preconstruction sales of crypts or niches if construction had not commenced prior to January 1.
        1. MAUSOLEUMS          Total Number              Number Sold                                          Unsold Inventory
Indoor Crypts (spaces)
Outdoor Crypts (spaces)
             Niches

        2. MAUSOLEUMS          Total Number              Number Sold                                          Unsold Inventory
Indoor Crypts (spaces)
Outdoor Crypts (spaces)
             Niches

        3. MAUSOLEUMS          Total Number              Number Sold                                          Unsold Inventory
Indoor Crypts (spaces)
Outdoor Crypts (spaces)
             Niches

1. COLUMBARIUM                 Total Number              Number Sold                                          Unsold Inventory
             Niches

        2. COLUMBARIUM         Total Number              Number Sold                                          Unsold Inventory
             Niches

        3. COLUMBARIUM         Total Number              Number Sold                                          Unsold Inventory
             Niches

                               Attach additional sheets if needed.

EF-265-R11-0518-41000840-4
BOE-265 (P4) REV. 11 (05-18)
                                INSTRUCTIONS FOR FILING CLAIM FOR PROPERTY TAX EXEMPTION
                                           UNDER THE CEMETERY EXEMPTION PROVISIONS

FILING OF CLAIM
Claims for the cemetery exemption must be signed and filed with the county Assessor.
An officer or duly authorized representative of the organization owning the property must sign the claim.
The Assessor will supply claim forms. 
TIME FOR FILING
To receive the full exemption the claim must be filed each year on or before February 15. Only 90 percent of any tax or penalty or interest thereon may be 
canceled or refunded when a claim is filed between February 16 of the current year and January 1 of the following calendar year; if the application is filed 
thereafter, only 85 percent of any tax or penalty or interest thereon may be canceled or refunded. In no case, however, is the tax, penalty, and interest for 
a given year to exceed $250.
PREPARATION OF CLAIM
All claimants must execute the claim and, except where an exemption is being claimed for inactive cemetery property, provide the property information 
requested in Section A. Only claimants organized for profit need complete Section B. All questions must be answered. If you do not answer all the 
questions, your claim may be denied. Leave no blanks; use “no,” “none,” or “not applicable” where needed.
If the entire property is not qualified, a partial exemption will be granted for any portion which satisfies the requirements.
FISCAL YEAR
The fiscal year for which an exemption is sought must be entered correctly. The proper fiscal year follows the lien date (12:01 a.m., January 1) as of which 
the taxable or exempt status of the property is determined. For example, a person filing a timely claim in February 2011 would enter “2011-2012” on line 
four of the claim; a “2010-2011” entry on a claim filed in February 2011 would signify that a late claim was being filed for the preceding fiscal year.
USE OF PROPERTY
Check the appropriate box to indicate whether or not the owner is organized or operates for profit. If organized as a nonprofit corporation, enter the date(s) 
of incorporation and any amendments to the articles of incorporation on line 6.
A nonprofit organization filing for the first time must attach a certified copy of the Articles of Incorporation or comparable instrument for unincorporated 
organizations, together with all amendments and revisions thereto. After the first filing, only subsequent amendments or revisions to the articles or comparable 
instrument need be submitted with each claim. Approval of your claim for cemetery exemption cannot be given if proper documentation is not on file in the 
Assessor’s Office.
EXEMPTION
Check the appropriate box and enter the Assessor’s parcel number or legal description when required. If necessary, use the back of the claim for lengthy 
legal descriptions or attach an additional sheet.This completes the claim only for organizations claiming a total exemption of an inactive cemetery 
property, in which no portion is being leased, rented, or held for sale by the claimant. Claims for all other properties must include Section A.

                                      SECTION A: INFORMATION CONCERNING THE PROPERTY
Except as indicated in the preceding paragraph, Section A is to be completed by both profit-making and nonprofit cemetery organizations. A separate 
Section A must be completed and filed for each property for which total or partial exemption is sought. The information furnished must be restricted to the 
particular property. Give the exact name of the organization, address of the property, and the county of location.
The term property as used here means any operating unit of property consisting of one parcel or several contiguous parcels for which an exemption is 
sought even though there may be several improvements and separate buildings thereon. All personal property for which an exemption is sought should be 
listed. If more than one Section A is filed, each Section A should be numbered for convenient reference.
PROPERTY DESCRIPTION
List each parcel on which a portion of the operating cemetery is located. Enter the Assessor’s parcel number(s) or legal description(s). Indicate the total 
area (in acres) of all parcels. Use additional sheets if necessary. If the owner has recorded a “Declaration of Intention” or “Declaration of Dedication” of the 
property for which the exemption is claimed, or if cemetery zoning or a special use permit was granted for the property, check the appropriate box(es) and 
enter the corresponding date(s) or recorder’s reference(s). If dedication and zoning are not required, check the corresponding box and explain.
OWNER AND OPERATOR
Check the appropriate boxes to identify the owner and operator of the property and the classifications of property for which total or partial exemption is 
sought. If an organization or individual other than the claimant owns or operates the property, identify the organization or individual in the space provided.
LEASED OR RENTED TO OTHERS
If any portion of the property is rented, leased, or being used or operated by some other person or organization, copies of their leases or agreements must 
be submitted. If the leases or other agreements have been filed in prior years, it is only necessary to attach copies of subsequent extensions, modifications, 
and changes.
LAND USE
Designate the exact acreage for each use. Report one combined figure for all building sites other than mausoleums and columbariums, which must be 
shown separately. Report appurtenant walkways, gardens, and parking lots separately. The total acreage includes both cemetery and noncemetery uses. 

EF-265-R11-0518-41000840-5
BOE-265 (P5) REV. 11 (05-18)
BUILDINGS AND IMPROVEMENTS
List all buildings and other improvements on the land, such as mausoleums, columbariums, chapels, corporation yard improvements, irrigation systems, 
mortuaries, and crematoriums (do not include landscaping). List separately any improvements used partially for exempt purposes and partially for taxable 
purposes. Use additional sheets if necessary. Principal use column: List the principal use of each. Other use or uses column: List all other uses of specific 
buildings and improvements. Enter “none” if there is no other use.
PERSONAL PROPERTY
List all personal property for which an exemption is sought. Group items into broad categories such as cemetery maintenance tools and equipment, grave 
digging equipment, and office furniture. List separately any personal property used partially for exempt purposes and partially for taxable purposes. Principal 
use column: Indicate the principal use of the property (e.g., maintaining cemetery grounds). Other use or uses column: List any other uses (e.g., farming). 
Enter “none” if there is no other use. Leased personal property should be listed in the LEASED OR RENTED TO OTHERS section.

                            SECTION B: INVENTORY OF UNSOLD BURIAL SITES, CRYPTS, AND NICHES
Section B must be completed by all profit-making organizations (any claimant answering “yes” to question 5) seeking the cemetery exemption. List the 
owner’s inventory of unsold burial sites, crypts, and niches as of 12:01 a.m., January 1. Include those acquired by the owner through trades or defaulted 
contracts as unsold.
DEVELOPED CEMETERY PLOTS, LAWN CRYPTS, AND LAWN NICHES
Report cemetery plots in terms of number of burial sites and crypts. Land developed as burial sites, which are either in use or being offered for both at-need 
and pre-need sales, is to be reported separately from land designated and offered only for pre-need sales. Show (1) the total number, (2) the number sold, 
and (3) the unsold inventory. Developed burial sites row: report “developed” plots located in operating units of the cemetery in which burial activity takes  
place. Offered for pre-need sales only row: Limit number to plots in operating units of the cemetery which remain undeveloped or in a semi-developed state 
and in which no burial activity takes place. 
CRYPTS AND NICHES
Show (1) the total number of crypts or niches, (2) the number sold, and (3) the inventory on hand. Do not report preconstruction sales if construction had 
not commenced prior to the lien date.
ADDITIONAL INFORMATION
Upon request, the owner and the operator must furnish additional information to the Assessor. The Assessor may institute an audit or verification of the 
operations of the claimant.