MARK CHURCH
EF-268-A-R08-0512-41000413-1                                                                Assessor - County Clerk - Recorder
BOE-268-A (P1) REV. 08 (05-12)                                                              555 County Center
                                                                                            Redwood City, CA 94063
PUBLIC SCHOOL EXEMPTION                                                                     P 650.363.4500    F 650.599.7435
PROPERTY  USED  EXCLUSIVELY  BY            A  PUBLIC                                        email assessor@smcacre.org
                                                                                            web www.smcacre.org
SCHOOL,  COMMUNITY  COLLEGE,  STATE  COLLEGE, 
STATE UNIVERSITY, OR UNIVERSITY OF CALIFORNIA
FISCAL YEAR OF CLAIM 20 _____ - 20 _____ (see instructions)
      NAME AND MAILING ADDRESS
      (Make necessary corrections to the printed name and mailing address)
                                                                                            A claimant must complete and file this form 
                                                                                            with the Assessor by February 15.

IDENTIFICATION OF APPLICANT
NAME OF SCHOOL DISTRICT, ORGANIZATION, ETC.

MAILING ADDRESS

CITY, STATE, ZIP CODE

CORPORATE ID (IF ANY)

IDENTIFICATION OF PROPERTY 
NAME OF SCHOOL

ADDRESS OF PROPERTY (NUMBER AND STREET)

CITY, COUNTY, ZIP CODE                                                                             ASSESSOR’S PARCEL NUMBER

USE OF PROPERTY
R Check the type of qualifying exclusive use of the property
  PUBLIC SCHOOL                               STATE UNIVERSITY                              STATE COLLEGE
  COMMUNITY COLLEGE                           UNIVERSITY OF CALIFORNIA

IDENTIFICATION OF REAL PROPERTY OWNER
NAME OF OWNER

MAILING ADDRESS

CITY, STATE, ZIP CODE

                                                                          DATE LEASE SIGNED COMMENCEMENT DATE OF LEASE
 Yes   No    A copy of the lease agreement is attached.
 Yes   No    The lease confers upon the lessee the exclusive right to possess and use the property.

 Yes   No    The property, or a portion thereof, is a student bookstore that generates unrelated business taxable income as defined in section 
             512 of the Internal Revenue Code.

             If Yes  , a copy of the institution’s most recent tax return filed with the Internal Revenue Service must accompany this affidavit. 
             Property taxes are determined by establishing a ratio of the unrelated business taxable income to the bookstore’s gross 
             income.

Important: Failure to submit this affidavit will result in denial of the exemption. This claim only applies when lessees are public schools, community 
colleges, state colleges, state universities or the University of California. Submission of this claim after the due date will result in a portion of the 
exemption being denied.
                               THIS DOCUMENT IS SUBJECT TO PUBLIC INSPECTION

EF-268-A-R08-0512-41000413-2
BOE-268-A (P2) REV. 08 (05-12)

                LEASED PROPERTY AS OF JANUARY 1                              NAME AND ADDRESS OF PROPERTY OWNER
                                                                             (if different than the owner identified on page 1)
  Land (Legal description or map book, page and parcel number)

  Buildings and Improvements

 Personal Property (Describe by type, make, model and serial number. If 
 there are numerous properties, please attach a list that clearly identifies 
 the property and the name and address of the lessor.)

                                                            CERTIFICATION
I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing and all information hereon, including any 
                   accompanying statements or documents, is true and correct to the best of my knowledge and belief.
SIGNATURE OF PERSON MAKING CLAIM                                              DATE
t
NAME OF PERSON MAKING CLAIM                                                   TITLE

EMAIL ADDRESS                                                                 DAYTIME TELEPHONE
                                                                              ( )
                                                      INSTRUCTIONS FOR FILING 
This affidavit is required under section 3(d) of Article XIII of the Constitution of the State of California and the provisions of sections 202, 202.2, 202.5, 
202.6, 251, 254, 255, 259.10, 260, and 270 of the Revenue and Taxation Code.
IMPORTANT NOTICE
A qualifying institution is one whose property is used exclusively for public schools, community colleges, state colleges, state universities, and University of 
California.  It may include off-campus facilities owned or leased by an apprenticeship program sponsor, if such facilities are used exclusively by the public 
school for classes of related and supplemental instruction for apprentices or trainees conducted by the public school.
It is not necessary for the lessor to also file the Lessors' Exemption Claim for the property listed.  The benefit of a property tax exemption must inure to the 
lessee institution; the lessee may be entitled to claim a refund of taxes paid by the lessor. (See section 202.2 of the Revenue and Taxation Code.)
Include the terms of the agreement by which the public school obtained the use of real or personal property.  When the agreement is in writing, a copy of 
the document must accompany this claim form.
FILING OF AFFIDAVIT
To receive the full exemption, this form must be filed with the Assessor by February 15.  (Section 270 provides a partial exemption for late filing of the 
Public School Exemption.)  
IDENTIFICATION OF APPLICANT
Identify the name of the school, district or organization seeking exemption on the property.  Include the mailing address, and corporate identification 
number (if any).
IDENTIFICATION OF PROPERTY
Identify the location of the property of which you are seeking exemption; include the parcel number.  A separate claim form must be filed for each 
location.
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
Please check the applicable box that best describes the type of qualifying use of the property identified on this claim form. Also check the type of property 
of which you are seeking exemption. Identify whether your organization, as the lessee of the property, has the exclusive right of possession and use of 
the property.  
IDENTIFICATION OF OWNER
Identify owner of the property, include the mailing address.  Indicate if a copy of the lease agreement is attached to the claim form and provide the date 
the lease was signed and the commencement date of the lease.