MARK CHURCH
EF-267-L1-R15-0519-41000558-1                                                         Assessor - County Clerk - Recorder
BOE-267-L1 (P1) REV. 15 (05-19)                                                       555 County Center
                                                                                      Redwood City, CA 94063
                                                                                      P 650.363.4500    F 650.599.7435
                                                                                      email assessor@smcacre.org
WELFARE EXEMPTION SUPPLEMENTAL AFFIDAVIT,                                             web www.smcacre.org
LOW-INCOME HOUSING PROPERTY OF LIMITED PARTNERSHIP
This Claim is Filed for Fiscal Year 20_____ — 20_____
This is a Supplemental Affidavit filed with
BOE-267, Claim for Welfare Exemption (First Filing)
BOE-267-A, Claim for Welfare Exemption (Annual Filing)
If filed with BOE-267-A, check applicable boxes below
Secretary of State Form LP-2 filed within the last year
Limited Partnership Agreement, or other agreement, amended within the last year 
SECTION 1. IDENTIFICATION OF LIMITED PARTNERSHIP (LP) AND PROPERTY 
Name of Limited Partnership

Property Location (number and street)                                                 Date Property Acquired by LP

City, County, State, Zip Code

Supplemental Clearance Certificate (SCC) No. __________________________ (Provide copy of certificate with this claim and a copy of the Finding Sheet 
issued by the State Board of Equalization (Board) if filing with BOE-267.          
If you do not have an SCC, have you filed a claim for an SCC?           Yes         No
If no, see instructions for information on obtaining an SCC claim form 

SECTION 2. IDENTIFICATION OF MANAGING GENERAL PARTNER (MGP) 

Name of Organization                                                                  Corporate ID No. (or LLC No.)

Mailing address (number and street)                                                   Date Admitted into LP as GP

City, State, Zip Code

SECTION 3. GOVERNMENT FINANCING OR TAX CREDITS; USE RESTRICTION 
As to the low-income housing property for which this claim is made, the general partners of the limited partnership, including the managing general partner, 
certify that (check all applicable boxes):
A.  There is an enforceable and verifiable agreement with a public agency or a recorded deed restriction that restricts the projects’s usage and that 
provides that the units designated for use by lower-income households are continuously available to or occupied by lower-income households 
at rents that do not exceed those prescribed by section 50053 of the Health and Safety Code, or, to the extent that the terms of federal, state, 
or local financing or financial assistance conflicts with section 50053, rents that do not exceed those prescribed by the terms of the financing or 
financial assistance. For property tax exemption purposes, a unit is considered occupied by a lower income household if the occupants were 
qualified when their occupancy began, as long as the household income is not above 140% of area median income (“over-income” tenants), the 
unit is rent restricted, and the property receives federal low-income housing tax credits. See Revenue and Taxation Code section 214(g)(2)(A)((iii).
     If you are filing this supplemental affidavit with BOE-267 (First Filing), submit a copy of the regulatory agreement or recorded deed restriction.
B.  The funds which would have been necessary to pay property taxes are used to maintain the affordability of, reduce rents otherwise necessary for, 
the units occupied by lower-income households.

C.  At least one of the following criteria is applicable (check one):

(1)  The acquisition, construction, rehabilitation, development, or operation of the property is financed with government financing in the form 
of tax-exempt mortgage  revenue bonds; general obligation bonds; local, state, or federal loans or grants; or any loan insured, held, or 
guaranteed by the federal government; or project–based federal funding under section 8 of the Housing Act of 1937.  (The term “government 
financing” does not include federal rental assistance through tenant rent-subsidy vouchers under section 8 of the Housing Act of 1937.)
(2)  The owner is eligible for and receives state low-income housing tax credits pursuant to Revenue and Taxation sections 12205, 12206, 
17057.5, 17058, 23610.4, and 23610.5 or federal low-income housing tax credits pursuant to section 42 of the Internal Revenue Code.
                                      THIS DOCUMENT IS SUBJECT TO PUBLIC INSPECTION

EF-267-L1-R15-0519-41000558-2
BOE-267-L1 (P2) REV. 15 (05-19) 

SECTION 4. HOUSEHOLD INFORMATION 

A1.  Eligibility Based on Family Household Income - Lower Income Households
Section 214(g) of the California Revenue and Taxation Code provides that low-income housing property owned and operated by a limited partnership with 
a nonprofit corporation or eligible limited liability company as managing general partner can qualify for the Welfare Exemption from property taxes to the 
extent that the income of the households residing therein do not exceed amounts listed below: (See Section 4.A2 for income limit exception)

NO. OF PERSONS      MAXIMUM          NO. OF PERSONS       MAXIMUM  NO. OF PERSONS     MAXIMUM                    NO. OF PERSONS              MAXIMUM 
IN HOUSEHOLD        INCOME           IN HOUSEHOLD         INCOME   IN HOUSEHOLD       INCOME                     IN HOUSEHOLD                     INCOME
            1       $90,450                       3     $116,250           5          $139,500                         7                     $160,150
            2       $103,350                      4     $129,150           6          $149,850                         8                     $170,500

A2. Eligibility Based on Family Household Income - 140% of Area Median Income (AMI)
Section 214(g)(2)(A)(iii) of the Revenue and Taxation Code provides that under certain circumstances, property eligible for and receives federal low income 
housing tax credits (LIHTC) pursuant to Section 42 of the Internal Revenue Code can qualify for the welfare exemption from property taxes to the extent 
that the income of the households residing therein do not exceed amounts listed below:

        If  you  have  units  meeting  the  criteria  in A2,  that  do  not  meet  the  criteria  of A1  upon  which  you  seek  exemption,  check  here  to  confirm  the 
  property has federal LIHTC and submit BOE-267-L3,     Welfare Exemption Supplemental Affidavit, Households Exceeding Low-Income Limits -  
  “Over-Income” Tenant Data (140% AMI). BOE-267-L3 is confidential.

NO. OF PERSONS      140% AMI         NO. OF PERSONS     140% AMI   NO. OF PERSONS     140% AMI                   NO. OF PERSONS              140% AMI
IN HOUSEHOLD                         IN HOUSEHOLD                  IN HOUSEHOLD                                  IN HOUSEHOLD
1                   $134,050            3               $172,340           5          $206,850                         7                     $237,510
2                   $153,230            4               $191,520           6          $222,180                         8                     $252,840

       Note: If a dollar amount is not entered for each number of persons, contact the County Assessor for the figures.  The amounts are different for each
      county and change annually. In order to qualify all or a portion of the property for the exemption, you must have: (1) a signed statement for each 
        household  that  qualifies  (you  should  keep  the  statement  for  future  audits);  and  (2)  you  must  complete  parts  4B,  4C,  and  Section  5  below.

B.  List of Qualified Households
Attach  list  showing  desired  information  for  only  those  households  that  qualify.  Identify  which  units  qualify  under  the  140% AMI  criteria  indicated  in 
Section  4.A2. Also,  please  identify  the  vacant  units  reserved  for  low-income  households.  Provide  the  following  information: address/unit  number, 
number of persons in household, maximum income for household.
C.  Number of Units Serving Lower Income Households 
Note: Under section 214(g), the exemption percentage is the total number of "units serving lower income 
households"  divided by the total number of residential units. This percentage is applied to the entire property 
including "related facilities".                                                                                            EXAMPLE   ACTUAL

1. Number of residential units designated for use by or serving lower income households - lower income limits.                            88
2. Number of residential units occupied by households exceeding lower income limits but do not exceed 140% AMI 
    (“over-income” tenants), as reported on BOE-267-L3.                                                                                     2

3. Total number of qualified households (C1 + C2)                                                                                         90

4. Total number of residential units in property.                                                                                         100

5. Percentage which the number of "units serving lower income households" is of the total number of residential units.                    90%
    (C3 / C4 above)                                                                                                                       (90/100)

SECTION 5. PROPERTY USE.
Does this property include commercial space?         Yes   No  
Give a brief description of its use: 

EF-267-L1-R15-0519-41000558-3
BOE-267-L1 (P3) REV. 15 (05-19) 
SECTION 6. MANAGING GENERAL PARTNER REQUIREMENTS
A. Managing General Partner Designation.
    (1) Limited partnership agreement expressly designates the nonprofit corporation as the managing general partner.
    (2) Managing general partner is authorized to receive a partnership management fee or similar form of compensation payable in the amount
           and manner set forth in the limited partnership agreement or other agreement executed by all of the general partners.
    (3) Managing  general  partner  has  material  participation  in  the  control,  management  and  direction  of  the  limited  partnership’s
           business (see Section 6.B.).
    (4) Officers and directors of the for-profit general partners, for-profit limited partners, or any of its for-profit affiliates, do not, as individuals or
           collectively, have a controlling vote or majority interest in the managing general partner.
B. Material Participation.
      The managing general partner is a general partner that has “material participation” in the control, management, and direction of the limited 
      partnership’s business, in that the managing general partner has a right to vote in all the major decisions, including any actions which require 
      a vote of a majority in interest of the general partner; performs substantial management duties (at least 5 of the 12 duties listed in Section 
      6.C.); directly or indirectly, under its supervision, manages the limited partnership; annually conducts a physical inspection of the low-income
      housing property to ensure that the property is being used as low-income housing and meets all of the requirements of the welfare exemption
      for low-income housing properties; annually submits a certification to the County Assessor of the county in which the property is located that
      the low-income housing property meets all Welfare Exemption requirements for low-income housing properties.

C. Substantial Management Duties.

      The managing general partner actually performs at least 5 of 12 following partnership management duties: 
      (1) Managing general partner rents, maintains and repairs the low-income housing property, or if such duties are delegated to a property
           management agent, participates in hiring and overseeing the work of the property management agent.
      (2) Managing general partner participates in hiring and overseeing the work of all persons necessary to provide services for the management
           and operation of the limited partnership business.
      (3) Managing general partner executes and enforces all contracts executed by the limited partnership.
      (4) Managing general partner executes and delivers all partnership documents on behalf of the limited partnership.
      (5) Managing general partner prepares or causes to be prepared all reports to be provided to the partners or lenders on a monthly,
           quarterly, or annual basis consistent with the requirements of the limited partnership agreement.
      (6) Managing general partner coordinates all present and future development, construction, or rehabilitation of low-income housing property
           that is the subject of the limited partnership agreement.
      (7) Managing general partner monitors compliance with all government regulations and files or supervises the filing of all required documents
           with government agencies.
      (8) Managing general partner acquires, holds, assigns or disposes of property or any interest in property.
      (9) Managing general partner borrows money on behalf of the limited partnership, encumbers limited partnership assets, places title in the
           name of the nominee to obtain financing, prepays in whole or in part, refinances, increases, modifies or extends any obligation.
      (10)  Managing general partner pays organizational expenses incurred in the creation of the partnership and all operational expenses.
      (11) Managing general partner determines the amount and timing of distributions to partners and establishes and maintains all required
           reserves.
      (12) Managing  general  partner  ensures  that  charitable  services  or  benefits,  such  as  vocational  training,  education  programs,
           childcare and after-school programs, cultural activities, family counseling, transportation, meals, and linkages to health and/or social
           services are provided or information regarding charitable services or benefits are made available to the low-income housing tenants.

SECTION 7. DELEGATION OF AUTHORITY 
A. The person making this claim certifies that the limited partnership agreement (please check applicable box):
      Contains a delegation of authority clause
      Does not contain a delegation of authority clause
B. If the limited partnership agreement contains a delegation of authority clause, such clause provides that:
      The managing general partner may not delegate any of its partnership management duties, as identified in Rule 140.1, subdivision (a)(10) and 
      defined in Section 6 or
      The managing general partner may delegate its partnership management duties, as identified in Section 6, to persons who under its supervision, 
      may perform such duties for the partnership subject to the supervision by the managing general partner.
C. The managing general partner has delegated some or all of its partnership management duties identified in Section 6:
    Yes      No  
If yes, please list each duty delegated, the date delegated, and the person or entity performing such duty (attach additional pages if necessary):

                                        THIS STATEMENT IS SUBJECT TO AUDIT

EF-267-L1-R15-0519-41000558-4
BOE-267-L1 (P4) REV. 15 (05-19) 

SECTION 8. Certification: 
The form must be certified by the managing general partner and all of the general partners of the limited partnership (please attach additional pages if 
necessary).

                                                              CERTIFICATION
 I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing and all information contained herein, including 
           any accompanying statements or documents, is true, correct, and complete to the best of my knowledge and belief.
NAME OF LIMITED PARTNERSHIP

LOCATION OF LIMITED PARTNERSHIP PROPERTY

NAME AND TITLE OF MANAGING GENERAL PARTNER (typed or printed) TELEPHONE     DATE
                                                              (       )
SIGNATURE OF MANAGING GENERAL PARTNER                         EMAIL ADDRESS
t
NAME AND TITLE OF GENERAL PARTNER (typed or printed)          TELEPHONE     DATE
                                                              (       )
SIGNATURE OF GENERAL PARTNER                                  EMAIL ADDRESS
t
NAME AND TITLE OF GENERAL PARTNER (typed or printed)          TELEPHONE     DATE
                                                              (       )
SIGNATURE OF GENERAL PARTNER                                  E-MAIL ADDRESS
t
NAME AND TITLE OF GENERAL PARTNER (typed or printed)          TELEPHONE     DATE
                                                              (       )
SIGNATURE OF GENERAL PARTNER                                  EMAIL ADDRESS
t
NAME AND TITLE OF GENERAL PARTNER (typed or printed)          TELEPHONE     DATE
                                                              (       )
 SIGNATURE OF GENERAL PARTNER                                 E-MAIL ADDRESS
t
NAME AND TITLE OF GENERAL PARTNER (typed or printed)          TELEPHONE     DATE
                                                              (       )
SIGNATURE OF GENERAL PARTNER                                  EMAIL ADDRESS
t
NAME AND TITLE OF GENERAL PARTNER (typed or printed)          TELEPHONE     DATE
                                                              (       )
SIGNATURE OF GENERAL PARTNER                                  EMAIL ADDRESS
t

EF-267-L1-R15-0519-41000558-5
BOE-267-L1 (P5) REV. 15 (05-19) 

             INSTRUCTIONS FOR FILING WELFARE EXEMPTION SUPPLEMENTAL AFFIDAVIT
                                LOW-INCOME HOUSING PROPERTY OF LIMITED PARTNERSHIP

FILING OF AFFIDAVIT
This affidavit is required under the provisions of sections 214(g), 214.15, 251, and 254.5 of the Revenue and Taxation Code and must be filed when   
seeking exemption on low-income housing property owned and operated by a limited partnership. The income of the occupants must not 
exceed certain limits (see section 4 of the claim form). This affidavit supplements the claim for Welfare Exemption and must be filed with 
the county assessor by February 15 to avoid a late filing penalty under section 270. If you do not complete and file this form, you may be 
denied the exemption.  The claimant  should provide each household living on the property with a copy of BOE-267-L-A, Lower Income 
Households, Family Household Income Reporting Worksheet. 
The organization claiming the exemption keeps the completed, signed statements in case of further audit. Do not submit the 
worksheets with your filing.

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 2018
would enter “2018-2019” on line four of the claim; a “2017-2018” entry on a claim filed in February 2018 would signify that a late claim was 
being filed for the preceding fiscal year.

SECTION  1.  Identification of Limited Partnership (LP) and Property. Identify the name of the limited partnership that owns the low-income 
housing property, location of the low-income housing property, county in which the property is located, and date the property was acquired by the limited  
partnership.  As a prerequisite to being granted the Welfare Exemption for low-income housing property owned by a limited partnership, the limited  
partnership must qualify for a Supplemental Clearance Certificate for Limited Partnership for Low-Income Housing Property – Welfare Exemption  
(BOE-277-SCC) (hereinafter referred to as “SCC”) on the property.  If the limited partnership holds a SCC for the low-income housing 
property, identify the certificate number or indicate whether or not an application is pending with the Board. For additional information 
regarding the requirements, see Property Tax Rules 140, 140.1, and 140.2, available on the Board’s website at www.boe.ca.gov.  

SECTION  2.  Identification of Managing General Partner (MGP).  Identify the name of the managing general partner, corporate identification 
number or limited liability company number, mailing address of the managing general partner, and the date the managing general partner was admitted to 
the limited partnership.  As a prerequisite to being granted the Welfare Exemption for low-income housing property owned by a limited partnership, 
the managing general partner of the limited partnership must qualifyOrganizationalfor an Clearance Certificate for Welfare or Veterans’ Organization 
Exemption (BOE-277-OCC) (hereinafter referred to as “OCC”) from the State Board of Equalization (Board). 

SECTION  3.  Government Financing or Tax Credits; Use Restriction.  Check all applicable boxes to certify if (1) the property use is restricted            to 
low-income housing by a recorded regulatory agreement or recorded deed restriction, and (2) the funds that would have been necessary 
to pay property taxes are used to maintain the affordability of the housing or to reduce the rents for the units occupied by lower-income 
households, and (3) the property receives either government financing or state/federal low-income housing tax credits. 

SECTION 4B. List of Qualified Households.    Include a list of all households that qualify for exemption based on the maximum 
income level for the county for the claim year where the property is located (see dollar amounts in Sections 4.A1 and 4.A2).  Additionally, 
claimant must submit BOE-267-L3 to include a list of households that qualify for exemption under the 140% AMI criteria indicated in 
Section 4.A2. Also, please list vacant units held for low-income housing tenants.

SECTION 4C. 
Revenue and Taxation Code section 214(g)(1) states rental housing and “related facilities” are entitled to a partial exemption equal to that 
percentage of the value of the property that is equal to the percentage that the number of units serving lower income households represents 
of the total number of residential units. The percentage determined shall apply to the total value of both improvements and land. Identify 
the number of units designated for use by or serving lower income households and the total number of residential units for the property.

Units Serving Lower Income Households. 
“Units serving lower income households” shall mean units that are occupied by lower income households at an affordable rent, as defined 
in section 50053 of the Health and Safety Code or, to the extent that the terms of federal, state, or local financing or financial assistance 
conflicts with section 50053, rents that do not exceed those prescribed by the terms of the financing or financial assistance. Effective 
October 13, 2017, pursuant to Revenue and Taxation Code section 214(g)(2)(A)(iii), a unit in a property that receives federal low income 
housing tax credits shall continue to be treated as occupied by a lower income household if the occupants were lower income households on 
the lien date in the fiscal year in which their occupancy of the unit commenced and the unit continues to be rent restricted, notwithstanding 
an increase in the income of the occupants of the unit to 140 percent of area median income (AMI), adjusted for family size (“over-income” 
tenants). Units reserved for lower income households at an affordable rent that are temporarily vacant due to tenant turnover or repairs 
shall be counted as occupied.

EF-267-L1-R15-0519-41000558-6
BOE-267-L1 (P6) REV. 15 (05-19) 

                     INSTRUCTIONS FOR FILING WELFARE EXEMPTION SUPPLEMENTAL AFFIDAVIT
                                LOW-INCOME HOUSING PROPERTY OF LIMITED PARTNERSHIP

Related Facilities. 
Revenue and Taxation Code section 214(g)(3)(B) states “related facilities” means any manager’s units and any and all common area 
spaces that are included within the physical boundaries of the rental housing development, including, but not limited to, common area 
space, walkways, balconies, patios, clubhouse space, meeting rooms, laundry facilities, and parking areas, except any portions of the 
overall development that are nonexempt commercial space.

SECTION 5. 
This section requests information on any commercial space. If applicable, briefly describe the commercial space (i.e., multi-
story building with residential use on floors 2-5 and retail space on ground floor) and use.

SECTION 6.A. Managing General Partner Designation.                  Check all applicable boxes. See Rule 140.1, subdivision (a)(6), which 
provides the definition of “managing general partner” of a limited partnership under Revenue and Taxation Code section 214(g).

SECTION 6.B. Material Participation.             A limited partnership, in which the managing general partner is an eligible nonprofit    
corporation or a limited liability company, may qualify for exemption for a particular property provided that the limited partnership  
agreement, or other agreement executed by all of the general partners, provides that the managing general partner is a general partner that      has 
“material participation” in the control, management, and direction of the limited partnership’s business. Check if applicable [see Rule 140.1,  
subdivision (a)(7)].

SECTION 6.C. Substantial Management Duties.                   A limited partnership in which the managing general partner is an eligible  
nonprofit corporation or limited liability company, may qualify for exemption for a particular property provided that the limited partnership  
agreement, or other agreement executed by all of the general partners, provides that the managing general partner is a general partner 
with “substantial management duties” [see Rule 140.1, subdivision (a)(10)]. Check only if 5 of the 12 management duties are performed 
by the managing general partner. 

SECTION 7. Delegation of Authority.  If the limited partnership agreement contains a delegation of authority clause, it may provide  
either that: (1) the managing general partner may not delegate any of its partnership management duties; or (2) the managing general  
partner may delegate some or all of its partnership management duties to persons who, under its supervision, may perform such duties on  
behalf of the limited partnership [see Rule 140.1, subdivision (d)]. If the managing general partner is authorized to delegate its partnership  
duties and elects to delegate one or more of its duties, the managing general partner must demonstrate that it is actually supervising the  
performance  of  the  delegated  duties.  If  the  agreement  contains  a  delegation  of  authority  clause  and  states  that  the  managing 
general partner may delegate its partnership management duties, list each duty delegated, the date each duty was delegated, and person  
performing such duty.

RECORDS AND DOCUMENTS MUST BE MAINTAINED BY THE MANAGING GENERAL PARTNER
A  copy  of  the  claim  form  and  supporting  documents  should  be  retained  by  the  managing  general  partner.  The  managing 
general  partner  must  maintain  records  and  documents  evidencing  the  partnership  management  duties  performed  by  the 
managing  general  partner.  Such  records  and  documents  may  include,  but  are  not  limited  to:  accounting  books  and  records; 
tax  returns;  budgets  and  financial  reports;  reports  required  by  lenders;  documents  related  to  the  construction  or  rehabilitation 
of  real  property;  legal  documents  such  as  contracts,  deeds,  notes,  leases,  and  deeds  of  trust;  documents  related  to      
complying with government regulations and filings; documents related to property inspections; documents related to charitable services or 
benefits provided or the information provided regarding such services or benefits; reports prepared for the partners; bank account records; 
audited annual financial statement of the limited partnership; and property management agreement.