MARK CHURCH
EF-58-H-R01-1212-41000828-1                                                                              Assessor - County Clerk - Recorder
BOE-58-H REV. 01 (12/12)                                                                                 555 County Center
AFFIDAVIT OF COTENANT RESIDENCY                                                                          Redwood City, CA 94063
                                                                                                         P 650.363.4500    F 650.599.7435
                                                                                                         email assessor@smcacre.org
                                                                                                         web www.smcacre.org

         NAME AND MAILING ADDRESS
         (Make necessary corrections to the printed name and mailing address)
                                                                                   Under the provisions of Revenue and Taxation Code section 
                                                                                   62.3, if certain conditions are met, a transfer of a cotenancy 
                                                                                   interest in real property from one cotenant to the other 
                                                                                   cotenant that takes effect upon the death of one cotenant is 
                                                                                   not a change in ownership.  This applies to transfers that 
                                                                                   occur on or after January 1, 2013.

The change in ownership exclusion for a transfer of an interest in real property between cotenants that takes effect upon the death of one cotenant
applies as long as all of the following are met:

•        The transfer is solely by and between two individuals who together own 100 percent of the real property in joint tenancy or tenancy in common.
•        As a result of the death of the transferor cotenant, the deceased cotenant’s interest in the real property is transferred to the surviving cotenant,
         resulting in the surviving cotenant owning 100 percent of the real property, and thereby terminating the cotenancy.
•        For the one-year period immediately preceding the death of the transferor cotenant, both of the cotenants were owners of record.
•        The real property was the principal residence of both cotenants immediately preceding the transferor cotenant’s death.
•        For the one-year period immediately preceding the death of the transferor cotenant, both of the cotenants continuously resided in the real property.
•        The surviving cotenant must sign, under penalty of perjury, an affidavit affirming that he or she continuously resided in the real property with the
         deceased cotenant for the one-year period immediately preceding the date of death.

NAME OF SURVIVING COTENANT

NAME OF DECEASED COTENANT                                                                                 DATE OF DEATH

STREET ADDRESS OF REAL PROPERTY                                                                           ASSESSOR’S PARCEL NUMBER (APN)

CITY, STATE, ZIP CODE

Property was eligible for:   Homeowners’ Exemption                           Disabled Veterans’ Exemption
Disposition of real property:
         Affidavit of death of joint tenant
         Decree of distribution pursuant to will or intestate succession    
         Action of trustee pursuant to terms of trust (Attach a complete copy of trust and all amendments)
1.Was this real property the principal residence of the deceased cotenant the one-year period prior to the date of death?      Yes       No
2.Was this real property the principal residence of the surviving cotenant the one-year period prior to the date of death?     Yes       No
3. Are there any other beneficiaries of the real property?                   Yes No
   If yes, please list other beneficiaries: ________________________________________________________________________________________

                                                      CERTIFICATION OF COTENANT
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 continuously resided with the 
decedent in this real property for the one-year period immediately preceding the decedent’s date of death.
SIGNATURE OF SURVIVING COTENANT                                                                           DATE
t
EMAIL ADDRESS                                                                                             TELEPHONE NUMBER

                                 THIS DOCUMENT IS SUBJECT TO PUBLIC INSPECTION