MARK CHURCH
EF-502-D-R11-0518-41001738-1                                                                Assessor - County Clerk - Recorder
BOE-502-D (P1) REV. 11 (05 8-1 )                                                            555 County Center
CHANGE IN OWNERSHIP STATEMENT                                                               Redwood City, CA 94063
                                                                                            P 650.363.4500    F 650.599.7435
DEATH OF REAL PROPERTY OWNER                                                                email assessor@smcacre.org
This notice is a request for a completed Change in                                          web www.smcacre.org
Ownership Statement. Failure to file this statement will 
result in the assessment of a penalty.
NAME AND MAILING ADDRESS
(Make necessary corrections to the printed name and mailing address)

                                                                     Section 480(b) of the Revenue and Taxation Code requires that 
                                                                     the personal representative file this statement with the Assessor 
                                                                     in each county where the decedent owned property at the time of 
                                                                     death. File a separate statement for each parcel of real property 
                                                                     owned by the decedent.

NAME OF DECEDENT                                                                                DATE OF DEATH

                      Did the decedent have an interest in real property in this county? If 
YES            NO                                                                           YES, answer all questions. If NO, sign and
                      complete the certification on page 2.
STREET ADDRESS OF REAL PROPERTY        CITY                                       ZIP CODE      ASSESSOR’S PARCEL NUMBER (APN)* 

                                                                                                *If more than 1 parcel, attach separate sheet.
DESCRIPTIVE INFORMATION          R    (IF APN UNKNOWN)              DISPOSITION OF REAL PROPERTY       R
Copy of deed by which decedent acquired title is attached.          Succession without a will                Decree of distribution 
                                                                                                             pursuant to will
Copy of decedent’s most recent tax bill is attached.                Probate Code 13650 distribution 
                                                                                                             Action of trustee pursuant 
Deed or tax bill is not available; legal description is attached.   Affidavit                                to terms of a trust
TRANSFER INFORMATION             R    Check all that apply and list details below.
Decedent’s spouse                      Decedent’s registered domestic partner
Decedent’s child(ren) or parent(s.) If qualified for exclusion from assessment, a Claim for Reassessment Exclusion for Transfer 
Between Parent and Child must be filed (see instructions).
Decedent’s grandchild(ren.) If qualified for exclusion from assessment, a Claim for Reassessment Exclusion for Transfer from 
Grandparent to Grandchild must be filed (see instructions).
Cotenant to cotenant. If qualified for exclusion from assessment, an Affidavit of Cotenant Residency must be filed (see 
instructions).
Other beneficiaries or heirs.
A trust.
NAME OF TRUSTEE                        ADDRESS OF TRUSTEE

List names and percentage of ownership of all beneficiaries or heirs:
          NAME OF BENEFICIARY OR HEIRS                   RELATIONSHIP TO DECEDENT               PERCENT OF OWNERSHIP RECEIVED

This property has been or will be sold prior to distribution. (Attach the conveyance document and/or court order).
NOTE: Sale of the property does not relieve the need to file a Claim for Reassessment Exclusion for Transfer Between Parent 
and Child if appropriate.
                                 THIS DOCUMENT IS NOT SUBJECT TO PUBLIC INSPECTION

EF-502-D-R11-0518-41001738-2
BOE-502-D (P2) REV. 11 (05-18)
  YES          NO      Will the decree of distribution include distribution of an ownership interest in any legal entity that owns real property 
                       in this county? If YES, will the distribution result in any person or legal entity obtaining control of more than 50% of 
                       the ownership of that legal entity?   YES              NO   If YES, complete the following section.
NAME AND ADDRESS OF LEGAL ENTITY                                                                NAME OF PERSON OR ENTITY GAINING SUCH CONTROL

  YES          NO      Was the decedent the lessor or lessee in a lease that had an original term of 35 years or more, including renewal 
                       options? If YES, provide the names and addresses of all other parties to the lease.
               NAME                             MAILING ADDRESS                                           CITY                   STATE       ZIP CODE

                                   MAILING ADDRESS FOR FUTURE PROPERTY TAX STATEMENTS
NAME

ADDRESS                                                                       CITY                                 STATE     ZIP CODE 

                                                             CERTIFICATION
  I certify (or declare) under penalty of perjury under the laws of the State of California that the information contained herein is true, 
                                      correct and complete to the best of my knowledge and belief.
SIGNATURE OF SPOUSE/REGISTERED DOMESTIC PARTNER/PERSONAL REPRESENTATIVE            PRINTED NAME 
t
TITLE                                                                                                          DATE

EMAIL ADDRESS                                                                                                  DAYTIME TELEPHONE
                                                                                                               ( )
                                                             INSTRUCTIONS
                              Failure to file a Change in Ownership Statement within the time prescribed by law may result in a penalty of 
                              either $100 or 10% of the taxes applicable to the new base year value 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
   IMPORTANT                  homeowners’ exemption or twenty thousand dollars ($20,000) if the property is not eligible for the homeowners’ 
                              exemption if that failure to file was not willful. This penalty will be added to the assessment roll and shall be 
                              collected like any other delinquent property taxes and subjected to the same penalties for nonpayment.
Section 480 of the Revenue and Taxation Code states, in part:
(a)Whenever there occurs any change in ownership of real property or of a manufactured home that is subject to local property taxation and is assessed
  by the county assessor, the transferee shall file a signed change in ownership statement in the county where the real property or manufactured home is
  located, as provided for in subdivision (c).  In the case of a change in ownership where the transferee is not locally assessed, no change in ownership
  statement is required.
(b) The personal representative shall file a change in ownership statement with the county recorder or assessor in each county in which the decedent
  owned real property at the time of death that is subject to probate proceedings.  The statement shall be filed prior to or at the time the inventory and
  appraisal is filed with the court clerk.  In all other cases in which an interest in real property is transferred by reason of death, including a transfer through
  the medium of a trust, the change in ownership statement or statements shall be filed by the trustee (if the property was held in trust) or the transferee
  with the county recorder or assessor in each county in which the decedent owned an interest in real property within 150 days after the date of death.
The above requested information is required by law. Please reference the following:
•   Passage of Decedent’s Property: Beneficial interest passes to the decedent's heirs effectively on the decedent's date of death. However, a document 
    must be recorded to vest title in the heirs. An attorney should be consulted to discuss the specific facts of your situation.
•   Change in Ownership: California Code of Regulations, Title 18, Rule 462.260(c), states in part that “[i]nheritance (by will or intestate succession)” 
    shall be "the date of death of decedent."
•   Inventory and Appraisal: Probate Code, Section 8800, states in part, "Concurrent with the filing of the inventory and appraisal pursuant to this section, 
    the personal representative shall also file a certification that the requirements of Section 480 of the Revenue and Taxation Code either:
    (1)  Are not applicable because the decedent owned no real property in California at the time of death
    (2) Have been satisfied by the filing of a change in ownership statement with the county recorder or assessor of each county in California in which 
      the decedent owned property at the time of death."
•   Parent/Child and Grandparent/Grandchild Exclusions: A claim must be filed within three years after the date of death/transfer, but prior to the date 
    of transfer to a third party; or within six months after the date of mailing of a Notice of Assessed Value Change, issued as a result of the transfer of 
    property for which the claim is filed. An application may be obtained by contacting the county assessor.
•   Cotenant to cotenant. An affidavit must be filed with the county assessor. An affidavit may be obtained by contacting the county assessor.
This statement will remain confidential as required by Revenue and Taxation Code Section 481, which states in part: 
"These statements are not public documents and are not open to inspection, except as provided by Section 408."