MARK CHURCH
EF-502-AH-R16-0617-41001185-1                                                            Assessor - County Clerk - Recorder
BOE-502-AH(P1) REV. 1  (06 -17)6                                                         555 County Center
                                                                                         Redwood City, CA 94063
CHANGE OF OWNERSHIP STATEMENT                                                            P 650.363.4500    F 650.599.7435
This statement represents a written request from the Assessor.                           email assessor@smcacre.org
                                                                                         web www.smcacre.org
Failure to file will result in the assessment of a penalty.
FILE THIS STATEMENT BY:______________________
                                 FORASSESSOR’SUSEONLY
                                                                               NUMBER

                                                                               SELLER/TRANSFEROR

                                                                               (        )
                                                                               ADDRESS

STREETADDRESSORPHYSICALLOCATIONOFREALPROPERTY

                                                                                                                      MO DAY YEAR
YES            NO   Thispropertyisintendedasmyprincipalresidence.IfYES,pleaseindicatethedateofoccupancy
                    orintendedoccupancy.
YES            NO   Areyouadisabledveteranoraunmarriedsurvivingspouseofadisabledveteranwhowas
                    compensatedat100%bytheDepartmentofVeteransAffairs?
MAILPROPERTYTAXINFORMATIONTO(NAME)

MAILPROPERTYTAXINFORMATIONTO(ADDRESS)                                          CITY                                   STATE ZIPCODE

PART 1. TRANSFER INFORMATION                        Please complete all statements.

YES NO
               A. Thistransferissolelybetweenspouses (addition or removal of a spouse, death of a spouse, divorce settlement, etc.).
               B. ThistransferissolelybetweendomesticpartnerscurrentlyregisteredwiththeCaliforniaSecretaryofState (addition or removal of
               a partner, death of a partner, termination settlement, etc.).
          * C. Thisisatransfer:    between parent(s) and child(ren)            from grandparent(s) to grandchild(ren).
          * This       transferistheresultofacotenant’sdeath. Dateofdeath___________________________
          * E. This transaction is to replace a principal residence owned by a person 55 years of age or older.
               Withinthesamecounty?             YES        NO
          * F. ThistransactionistoreplaceaprincipalresidencebyapersonwhoisseverelydisabledasdefinedbyRevenueandTaxationCode
               section69.5.Withinthesamecounty?            YES NO
               G. This transaction is only a correction of the name(s) of the person(s) holding title to the property (e.g., a name change upon marriage).
               IfYES,pleaseexplain:
               H. Therecordeddocumentcreates,terminates,orreconveysalender'sinterestintheproperty.
               I. This transaction is recorded only as a requirement for financing purposes or to create, terminate, or reconvey a security interest
               (e.g., cosigner).IfYES,pleaseexplain:
               J. Therecordeddocumentsubstitutesatrusteeofatrust,mortgage,orothersimilardocument.
               K. Thisisatransferofproperty:
               1. to/fromarevocabletrustthatmayberevokedbythetransferorandisforthebenefitof
                           thetransferor,and/or thetransferor'sspouse          registereddomesticpartner.
               2. to/fromanirrevocabletrustforthebenefitofthe
                           creator/grantor/trustorand/or   grantor's/trustor’s grantor’s/trustor’s                    registereddomesticpartner.
               L. Thispropertyissubjecttoaleasewitharemainingleasetermof35yearsormoreincludingwrittenoptions.
               M. This is a transfer between parties in which proportional interests of the transferor(s) and transferee(s) in each and every parcel

               requir

          * O. Thistransferistothefirstpurchaserofanewbuildingcontaininganactivesolarenergysystem.
               P. Other.Thistransferisto____________________________________________________________
          *
               Please provide any other information that will help the Assessor understand the nature of the transfer.
                                 THIS DOCUMENT IS NOT SUBJECT TO PUBLIC INSPECTION

EF-502-AH-R16-0617-41001185-2
BOE-502-A H(P2) REV. 1 6(0 -17)6
PART 2. OTHER TRANSFER INFORMATION                                     Check and complete as applicable.
A. Dateoftransfer,ifotherthanrecordingdate:
B. Typeoftransfer:
     Purchase              Foreclosure      Gift       Tradeorexchange            Merger,stock,orpartnershipacquisition(FormBOE-100-B)
     Contractofsale.Dateof                                                                    Inheritance.Dateofdeath:
     Sale/leaseback             Creationofalease       Assignment of a lease        Terminationofalease.Dateleasebegan:
                                Original term in years (including written options): Remaining term in years (including written options):
     Other.Pleaseexplain:
C. Onlyapartialinterestinthepropertywastransferred.           YES   NO              IfYES,indicatethepercentagetransferred:             %
PART 3. PURCHASE PRICE AND TERMS OF SALE                               Check and complete as applicable.
A. T                                                                                                                  $_______________
B. Cashdownpaymentorvalueoftradeorexchangeexcludingclosingcosts                                                   Amount$_______________
C. Firstdeedoftrust@_           %interestfor           years.   Monthlypayment$_____________                      Amoun_______________
     FHA(___ DiscountPoints)             Cal-Vet       VA(___DiscountPoints)        Fixedrate        Variable rate
     Bank/Savings&Loan/CreditUnion               Loancarriedbyseller
     Balloonpayment$_____________                Duedate:_____________
D. Seconddeedoftrust@______%interestfor______ years.Monthlypayment$_____________                                  Amount$_______________
     Fixedrate             Variable rate    Bank/Savings&Loan/CreditUnion           Loancarriedbyseller
     Balloonpayment$_____________                Duedate:_____________
E. WasanImprovementBondorotherpublicfinancingassumedbythebuyer?                     YES       NO     Outstandingbalance$_______________
F. Amount,ifany,ofrealestatecommissionfeespaidbythebuyerwhicharenotincludedinthepurchaseprice                      $_______________
G. Thepropertywaspurchased:       Throughrealestatebroker.Brokername:                                Phonenumber:  (        )
     Direct from seller         From a family member-Relationship 
     Other.Pleaseexplain:
H. Pleaseexplainanyspecialterms,sellerconcessions,broker/agentfeeswaived,financing,andanyotherinformation(e.g.,buyerassumedthe
   existingloanbalance)thatwouldassisttheAssessorinthevaluationofyourproperty.

PART 4. PROPERTY INFORMATION                                           Check and complete as applicable.
A. Type of property transferred
     Single-family residence                                                      Co-op/Own-your-own              Manufacturedhome
     Multiple-familyresidence.Numberofunits:                                      Condominium                     Unimprovedlot
     Other.Description:(i.e.,timber,mineral,waterrights,etc.)                     Timeshare                       Commercial/Industrial

B.   YES        NO Personal/businessproperty,orincentives,providedbysellertobuyerareincludedinthepurchaseprice.Examplesofpersonal
                     propertyarefurniture,farmequipment,machinery,etc.Examplesofincentivesareclubmemberships,etc.Attachlistifavailable.
   IfYES,enterthevalueofthepersonal/businessproperty:                  $                             Incentives   $
C.   YES        NO Amanufacturedhomeisincludedinthepurchaseprice.
   IfYES,enterthevalueattributedtothemanufacturedhome:                            $
     YES        NO Themanufacturedhomeissubjecttolocalpropertytax.IfNO,enterdecalnumber:
D.   YES        NO Thepropertyproducesrentalorotherincome.
   IfYES,theincomeisfrom:         Lease/rent           Contract     Mineral rights            Other:
E. Theconditionofthepropertyatthetimeofsalewas:               Good                  Average   Fair          Poor
Pleasedescribe:__________________________________________________________________________________________________
                                                              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 belief. 
SIGNATUREt OF BUYER/TRANSFEREE OR CORPORATE OFFICER                                 DATE                          TELEPHONE
                                                                                                                  (        )
NAME OF BUYER/TRANSFEREE/PERSONALREPRESENTATIVE/CORPORATE OFFICER (PLEASE PRINT) TITLE                            EMAILADDRESS

                           TheAssessor’sofficemaycontactyouforadditionalinformationregardingthistransaction.

EF-502-AH-R16-0617-41001185-3
BOE-502-A H(P3) REV. 1 6(0 -17)6
                                                          IMPORTANT NOTICE
The law requires any transferee acquiring an interest in real property or manufactured home subject to local property taxation, and that is assessed by the 
county assessor, to file a change in ownership statement with the county recorder or assessor. The change in ownership statement must be filed at the 
time of recording or, if the transfer is not recorded, within 90 days of the date of the change in ownership, except that where the change in ownership has 
occured by reason of death the statement shall be filed within 150 days after the date of death or, if the estate is probated, shall be filed at the time the 
inventory and appraisal is filed. The failure to file a change in ownership statement within 90 days from the date a written request is mailed by the assessor 
results in a penalty of either: (1) one hundred dollars ($100), or (2) 10 percent of the taxes applicable to the new base year value reflecting the change in 
ownership of the real property or manufactured home, whichever is greater, but not to exceed five thousand dollars ($5,000) if the property is eligible for 
the homeowners' exemption of twenty thousand dollars ($20,000) if the property is not eligible for the homeowners' exemption if that failure to file was not 
willful. The assessor is required to mail the request to file a change in ownership statement to the transferee at the address specified for mailing tax 
information on either the recorded instrument, the document evidencing a transfer of an interest in real property or manufactured home, or on the filed 
preliminary change in ownership report, or, if an address is not specified for mailing tax information, to any address reasonably known to the assessor. 
This penalty will be added to the assessment roll and shall be collected like any other delinquent property taxes, and be subject to the same penalties for 
nonpayment.  
                                                          INFORMATION

location of the real property.
NOTE:  Your telephone number and/or email address is very important. If there is a question or a problem, the Assessor 
needs to be able to contact you.
                                                                                                should

  home

                                                                                         A claim form must be filed and all 
requirements met in order to obtain the exemption. Please contact the Assessor for a claim form.
PART 1:  TRANSFER INFORMATION
If you check YES to any of these statements, the Assessor may ask for supporting documentation.
C, D, E, F:
base.                                               A claim form must be filed and all requirements met in order to obtain any of 
these exclusions.       be

G:                                                                                                                     is

H:
in the property.
      "Beneficial interest"

I: A "cosigner"

M:                                                                                               liability
exactly the same.
N: Check YES only if this property is subject to a government or nonprofit affordable housing program that imposes restrictions. 
Property may qualify for a restricted valuation (i.e., may result in lower taxes).
O:                                                                                A claim form must be filed and all 
requirements met in order to obtain the exclusion. Contact the Assessor for a claim form.
PART 2:  OTHER TRANSFER INFORMATION
A:

B:                                                                                              a
sheet if necessary.
C.                                        inherit                                               Change 
in OwnershipStatement,      Death of Real Property Owner, 

EF-502-AH-R16-0617-41001185-4
BOE-502-AH          66-17)

PART 3: PURCHASE PRICE AND TERMS OF SALE
accurately
propertyY

A.  
        “Mortgage insurance”insuramortgagor’FHA
        .

B.costs.
        “Closing costs”   propertyseller
        ’
C.T
        A “balloon payment”        fi
        installment. 

D.T
E.

        An   “improvement bond or other public financing” property-speci
        fifi
        fi

F.   
G.   broker broker’number

“Direct from sellerfamily”
purchaproperty                     “From a family member” father
                                                                                        “OTHER”
provide a detailed description (attach a separate sheet if necessary).  
H. unrecorde propertyconcession

.
PART 4: PROPERTY INFORMATION
A.
B.busine
 machinery
homeowners’
provided.

C.
 V
.

D.
gene
E.                                                                      “fair ”or “poor”
brief description of repair needed.