MARK CHURCH
EF-58-AH-R18-0617-41002533-1                                                                 Assessor - County Clerk - Recorder
BOE-58-AH (P1) REV. 1 8(0 -16 7)                                                             555 County Center
                                                                                             Redwood City, CA 94063
CLAIM FOR REASSESSMENT EXCLUSION FOR                                                         P 650.363.4500    F 650.599.7435
TRANSFER BETWEEN PARENT AND CHILD                                                            email assessor@smcacre.org
                                                                                             web www.smcacre.org

          NAME AND MAILING ADDRESS 
          (Make necessary corrections to the printed name and mailing address.)

A.  PROPERTY
ASSESSOR’S PARCEL NUMBER

PROPERTY ADDRESS                                                                             CITY

RECORDER’S DOCUMENT NUMBER                                                                   DATE OF PURCHASE OR TRANSFER

PROBATE NUMBER (if applicable)                  DATE OF DEATH (if applicable)                DATE OF DECREE OF DISTRIBUTION (if applicable)

The disclosure of social security numbers is mandatory as required by Revenue and Taxation Code section 63.1.               [See Title 42 United 
States Code, section 405(c)(2)(C)(i) which authorizes the use of social security numbers for identification purposes in the administration of any 
tax.] A foreign national who cannot obtain a social security number may provide a tax identification number issued by the Internal Revenue 
Service. The numbers are used by the Assessor and the state to monitor the exclusion limit. 
B.  TRANSFEROR(S)/SELLER(S) (additional transferors please complete “B” on the reverse)
  1. Print full name(s) of transferor(s)
  2. Social security number(s)
  3. Family relationship(s) to transferee(s)
          If adopted, age at time of adoption
  4. Was this property the transferor’s principal residence?   Yes              No
          If yes, please check which of the following exemptions was granted or was eligible to be granted on this property:
                Homeowners’ Exemption  Disabled Veterans’ Exemption 
  5.      WUDQVIHU                                                              Yes        No
          If yes,,
          Assessor’s parcel number, address, date of transfer, names of all the transferees/buyers, and family relationship. Transferor’s principal

  6. Was only a partial interest in the property transferred?  Yes              No  If yes, percentage transferred           %
  7. Was this property owned in joint tenancy?   Yes           No
  8.      If the transfer was through the medium of a will and/or trust, you must attach a full and complete copy of the will and/or trust and all
          amendments.
                                                              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 that I am the parent or child (or transferor’s legal 
representative) of the transferees listed in Section C. I knowingly am granting this exclusion and will not file a claim to transfer the base year 
value of my principal residence under Revenue and Taxation Code section 69.5.
SIGNATUREt OF TRANSFEROR OR LEGAL REPRESENTATIVEPRINTED NAME                                 DATE

SIGNATUREt OF TRANSFEROR OR LEGAL REPRESENTATIVEPRINTED NAME                                 DATE

MAILING ADDRESS                                                                              DAYTIME PHONE NUMBER
                                                                                               ( )
CITY, STATE, ZIP                                                                             EMAIL ADDRESS

                                      (Please complete applicable information on reverse side.)
                                  THIS DOCUMENT IS NOT SUBJECT TO PUBLIC INSPECTION

EF-58-AH-R18-0617-41002533-2
BOE-58-AH (P2) REV. 1 8(0 6-17)
C. C. TRANSFEREE(S)/BUYER(S) TRANSFEREE(S)/BUYER(S)(additional(additional transfereestransferees pleaseplease cocomplete “C” below)mplete “C” below)

      1. Print full name(s) of transferee(s)
      2. Family relationship(s) to transferor(s)
                  If adopted, age at time of adoption
                  If stepparent/stepchild relationship is involved, was parent still married to or in a registered domestic partnership                                                                                                             (registered means
                  registered with the California Secretary of State) with stepparent on the date of purchase or transfer?                                                                                                      Yes           No
                  If no, was the marriage or registered domestic partnership terminated by:                                                                          Death                 Divorce/Termination of partnership
                  If terminated by death, had the surviving stepparent remarried or entered into a registered domestic partnership as of the date of purchase
                  or transfer?              Yes       No
                  If in-law relationship is involved, was the son-in-law or daughter-in-law still married to or in a registered domestic partnership with the
                  daughter or son on the date of purchase or transfer?                                                          Yes             No
                  If no, was the marriage or registered domestic partnership terminated by:                                                                          Death                 Divorce/Termination of partnership
                  If terminated by death, had the surviving son-in-law or daughter-in-law remarried or entered into a registered domestic partnership as of
                  the date of purchase or transfer?                                      Yes               No
      3. ALLOCATION OF ExCLUSION (If the full cash value of the real property transferred exceeds the one million dollar value exclusion, the3. ALLOCATION OF ExCLUSION (If the full cash value of the real property transferred exceeds the one million dollar value exclusion, the
                  transferee must specify on an attachment to this claim the amount and allocation of the exclusion that is being sought.)transferee must specify on an attachment to this claim the amount and allocation of the exclusion that is being sought.)

                                                                                                                        CERTIFICATIONCERTIFICATION

II certifycertify (or(or declare)declare) underunder penaltypenalty ofof perjuryperjury underunder thethe lawslaws ofof thethe StateState ofof CaliforniaCalifornia thatthat thethe foregoingforegoing andand allall informationinformation hereon,hereon, includingincluding anyany
accompanyingaccompanying statementsstatements oror documents,documents, isis truetrue andand correctcorrect toto thethe bestbest ofof mymy knowledgeknowledge andand thatthat II amam thethe parentparent oror childchild (or(or transferee’stransferee’s legallegal
representative)representative) ofof thethe transferorstransferors listedlisted inin SectionSection B;B; andand thatthat allall ofof thethe transfereestransferees areare eligibleeligible transfereestransferees withinwithin thethe meaningmeaning ofof sectionsection 63.163.1 ofof
the Revenue and Taxation Code.the Revenue and Taxation Code.
SIGNATUREt        OF TRANSFEREE OR LEGAL REPRESENTATIVE                                            PRINTED NAME                                                                           DATE

MAILING ADDRESS                                                                                                                                                                           DAYTIME PHONE NUMBER
                                                                                                                                                                                          (            )
CITY, STATE, ZIP                                                                                                                                                                          EMAIL ADDRESS

Note: The Assessor may contact you for additional information.
                                                                               B. ADDITIONALTRANSFEROR(S)/SELLER(S) (continued)
                               NAME                                            SOCIAL SECURITY NUMBER                                                               SIGNATURE                                                        RELATIONSHIP

                                                                                    C. ADDITIONAL TRANSFEREE(S)/BUYER(S) (continued)
                                                                                                        NAME                                                                                                                         RELATIONSHIP

EF-58-AH-R18-0617-41002533-3
BOE-58-AH (P3) REV. 1 8(0 6-17)
                               CLAIM FOR REASSESSMENT EXCLUSION FOR TRANSFER BETWEEN PARENT AND CHILD
                                              Revenue and Taxation Code, Section 63.1

IMPORTANT: In order to qualify for this exclusion, a claim form must be completed and signed by the transferors and a transferee and filed with 
the Assessor. A claim form is timely filed if it is filed within three years after the date of purchase or transfer, or prior to the transfer of the real 
property to a third party, whichever is earlier. If a claim form has not been filed by the date specified in the preceding sentence, it will be timely if 
filed within six months after the date of mailing of a notice of supplemental or escape assessment for this property. If a claim is not timely filed, 
the exclusion will be granted beginning with the calendar year in which you file your claim. Complete all of Sections A, B, and C and answer 
each question or your claim may be denied. Proof of eligibility, including a copy of the transfer document, trust, or will, may be required. In 
situations where all information is not known by the due date, the parties should file this claim with as much information as possible, and later 
amend the claim with any revised information. Please note:

                    1. This exclusion only applies to transfers that occur on or after November 6, 1986;

                    2. In order to qualify, the real property must be transferred from parents to their children or children to their parents;

                    3. If you do not complete and return this form, it may result in this property being reassessed.

                    4. California law provides, with certain limitations, that a “change in ownership” does not include the purchase or transfer of:

                               • The

                               • the factored base year value of 

NOTE:     Effective January 1, 2009, Revenue and Taxation Code Section 63.1(j) allows a county board of supervisors to authorize a one-time 
processingfeeofnotmorethan$175torecovercostsincurredbythecountyassessorduetothefailureofaneligibletransfereetofileaclaimfor
the parent-child change in ownership exclusion after two written requests have been sent to an eligible transferee by the county assessor.