BOE-100-B (S1F) REV. 26 (8-23)         Submit completed form to:                                                                    STATE OF CALIFORNIA
                                                      STATE BOARD OF EQUALIZATION                                             BOARD OF EQUALIZATION
                                                      COUNTY-ASSESSED PROPERTIES DIVISION (MIC:64) 
                                                      PO BOX 942879, SACRAMENTO, CA 94279-0064
               STATEMENT OF CHANGE IN CONTROL AND OWNERSHIP OF LEGAL ENTITIES

                    STATE USE ONLY                            NAME AND ADDRESS OF LEGAL ENTITY:
                    CIC/CIO Date:

                    Result Code
                    FLE:
                    Sch. A
                    Sch. B
                    Date Entered:

               Legal Entity Identification Number: 
               Note: For corporations and limited liability companies, list the ID Number assigned by California Secretary of State. 
               For partnerships, list the Employer Identification Number (EIN).
               FILING REQUIREMENTS under Revenue and Taxation Code (R&TC) (see Important Notice [BOE-100-B, S3B]):
               This statement must be completed and filed with the Board of Equalization (BOE) within 90 days of a change in control (CIC) or 
               change in ownership (CIO) of a legal entity, if, as of that date, that legal entity (or entities under its ownership control) also owned (or 
               under certain circumstances leased) an interest in California real property. Additionally, this statement must also be filed within 90 days 
               of the BOE’s written request, regardless of whether a CIC or CIO occurred.
               Please refer to page 1 of the Instructions (BOE-100-B-INST) for definition of terms.
belowquestions *ALL                                                                                                                                                   must be completed.

                     YES   NO            1a.  On or after January 1,  and through the certification date below, has the legal entity filing this form (or any 
                                            legal entity[ies] under its ownership control) acquired ownership control (more than 50 percent of the ownership 
                                            interests) in any other legal entity, through one or more transactions; AND
                     YES   NO            1b.  Did the acquired legal entity(ies) (or any legal entity[ies] under its ownership control) hold any interests in real 
                                            property in California on the date of acquisition?
                                         *If you answered “yes” to both parts of question 1 above, R&TC section 64(c) applies. Complete Schedule A.

                     YES   NO            2a.  On or after January 1,  and through the certification date below, has any person or legal entity (or any 
                                            legal entity[ies] under its ownership control) acquired ownership control (more than 50 percent of the ownership 
                                            interests) in the legal entity filing this form (or any legal entity[ies] under its ownership control), through one or 
                                            more transactions; AND
                     YES   NO            2b.  Did the legal entity filing this form (or any legal entity[ies] under its ownership control) hold any interests in real 
                                            property in California on the date of acquisition?
                                         *If you answered “yes” to both parts of question 2 above, R&TC section 64(c) applies. Complete Schedule A.

                     YES   NO            3a.  Since March 1, 1975, has any California real property that was transferred to the filing legal entity been excluded 
                                            from reassessment under R&TC section 62(a)(2); AND
                     YES   NO            3b.  Has cumulatively more than 50 percent of any original co-owners’ interests in the legal entity filing this form 
                                            transferred since the date the real property was originally excluded from reassessment?
                                         *If you answered “yes” to both parts of question 3 above, R&TC section 64(d) applies. Complete Schedule B.
                                                                                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, correct, and complete to the best of my knowledge and belief.
                    SIGNATURE (required)                                          TITLE OF PERSON CERTIFYING INFORMATION EMAIL ADDRESS (required)

                    PRINT/TYPE NAME OF PERSON CERTIFYING (required)               TELEPHONE NUMBER (required)            DATE (required)

                    This statement shall be signed either by an officer, partner, or an employee or agent who has been designated in writing by the board 
                                         of directors, partnership, limited liability company, or other entity to sign such statements on its behalf.
                                              NOTE: An electronic, faxed, or incomplete certification may be subject to penalty.
                                             THIS STATEMENT IS SUBJECT TO AUDIT AND IS NOT A PUBLIC DOCUMENT

BOE-100-B (S1B) REV. 26 (8-23)                                                                                         STATE OF CALIFORNIA
                                                                                                             BOARD OF EQUALIZATION
                                    SCHEDULE A: CHANGE IN CONTROL OF A LEGAL ENTITY 
                                                           (Pursuant to California R&TC section 64(c))
        •   Complete this schedule if you answered “yes” to both parts of either question 1 or 2 on the certification page (S1F)
        •   Complete one Schedule A for each directly acquired entity and each entity or subsidiary under the control of each directly 
            acquired entity (see page 3 of the Instructions [BOE-100-B-INST]).

Please answer ALL of the items below.
1a. Provide all of the following information about the ACQUIRED legal entity:
NAME OF THE ACQUIRED LEGAL ENTITY

CORPORATE/LIMITED LIABILITY COMPANY IDENTIFICATION NUMBER (issued by CA Secretary of State)           PARTNERSHIP IDENTIFICATION NUMBER (EIN)

MAILING ADDRESS (street, PO box, city, state, and ZIP Code)

CONTACT PERSON                                                          TELEPHONE NUMBER              EMAIL ADDRESS

1b. Provide all of the following information about the ACQUIRING legal entity:
NAME OF THE ACQUIRING PERSON OR LEGAL ENTITY

CORPORATE/LIMITED LIABILITY COMPANY IDENTIFICATION NUMBER (issued by CA Secretary of State)           PARTNERSHIP IDENTIFICATION NUMBER (EIN)

MAILING ADDRESS (street, PO box, city, state, and ZIP Code)

CONTACT PERSON                                                          TELEPHONE NUMBER              EMAIL ADDRESS

2. Provide the following information about the change in control (CIC) of the acquired legal entity
   a. Date ownership control (that is, transfer of more than 50 percent of the ownership interests) was obtained:                             
   b. Description of the transaction.                                                                                  (month/day/year)
   c.  If an indirect CIC also occurred, identify each entity or subsidiary under the acquired entity’s control, provide the legal entity 
     identification number for each indirectly acquired entity, and explain the relationships between all entities involved in the transfer. 
     Attach an additional sheet, if necessary.

3.  Identify the ownership interests held by the person or legal entity in the acquired legal entity before and after the date of the CIC. 
  Attach an additional sheet, if necessary. IMPORTANT: If any interest(s) is held by a trust, you must indicate whether the trust is 
  revocable or irrevocable, identify the beneficiaries of the trust, and identify the percentage of interests each beneficiary held in the 
  trust, both before and after the acquisition.
                                                                                                      PERCENTAGE OF INTEREST HELD
                              NAME OF PERSON OR LEGAL ENTITY (OR TRUST)                               BEFORE                     AFTER* 
                                                                                                      ACQUISITION DATE ACQUISITION DATE

*The acquiring person or legal entity must identify the percentage interest they held before and after the acquisition.

BOE-100-B (S2F) REV. 26 (8-23)                                                                                             STATE OF CALIFORNIA
                                                                                                               BOARD OF EQUALIZATION
                                                              Schedule A continued
4. Transfer Information:  Complete all statements as they pertain to ownership interest of a legal entity(ies); not transfers of real 
YES    NO                     property interests.
             a.  This transfer was solely between spouses or registered domestic partners. If transfer was due to death, provide date of 
                death: 
             b.  This transfer of ownership interests was between parties (for example, a transfer into or out of a legal entity or a transfer 
                between legal entities) in which the proportional ownership interests of the transferor(s) and transferee(s) remain exactly 
                the same before and after the transfer.
             c.  This transfer of ownership interests was a nontaxable reorganization between corporations that are members of an 
                affiliated group before and after the transfer.
NOTE:  If you answered “yes” to item b or c listed above, you must attach additional documentation, such as organizational charts 
    showing before and after the transfer (see page 4 of the Instructions for documentation required).
5. Real Property Schedule:
Please list all interests in real property in California held by the acquired legal entity (or any legal entity[ies] under its ownership 
control), as of the date that ownership control was obtained (the acquisition date). See page 1 of the Instructions for definition of 
“interests in real property.” IMPORTANT: Also attach a list identifying the name and identification number of each entity under the 
acquired entity’s control.
a.  Property Owned by Acquired Legal Entity and Entities Under Its Control (see item 2c for required explanation of relationships 
    between entities)
                                                                                                          TYPE OF PROPERTY (CHECK ALL THAT APPLY)
    NAME OF OWNER                                LOCATION                    ASSESSOR’S PARCEL  CO. NO.          IMPROVEMENTS     FIXTURES
                                              (STREET ADDRESS/CITY)               NUMBER                  LAND   (BLDG./STRUCTURE)

b. Property that is Leased to the Acquired Legal Entity and Any Entities Under Its Control
                                                                                                                 IDENTIFY TYPE OF LEASE  
                                                                                                               (MUST CHECK ALL THAT APPLY)
    NAME OF LESSEE                               LOCATION                    ASSESSOR’S PARCEL  CO. NO.     PUBLIC ENTITY      LEASED 35+ YEARS 
                                              (STREET ADDRESS/CITY)               NUMBER
                                                                                                            (POSSESSORY        (REMAINING TERM 
                                                                                                               INTEREST)    INCLUDING OPTIONS)

COUNTY IDENTIFICATION NUMBERS (CO. NO.) (PROVIDED FOR PROPERTY SCHEDULES ABOVE)
01 Alameda       08 Del Norte  15 Kern           22 Mariposa   29 Nevada     36 San Bernardino  43 Santa Clara   50 Stanislaus    57 Yolo
02 Alpine        09 El Dorado  16 Kings          23 Mendocino  30 Orange     37 San Diego       44 Sana Cruz     51 Sutter        58 Yuba
03 Amador        10 Fresno     17 Lake           24 Merced     31 Placer     38 San Francisco   45 Shasta        52 Tehama
04 Butte         11 Glenn      18 Lassen         25 Modoc      32 Plumas     39 San Joaquin     46 Sierra        53 Trinity
05 Calaveras     12 Humboldt   19 Los Angeles    26 Mono       33 Riverside  40 San Luis Obispo 47 Siskiyou      54 Tulare
06 Colusa        13 Imperial   20 Madera         27 Monterey   34 Sacramento 41 San Mateo       48 Solang        55 Tuolumne
07 Contra Costa  14 Inyo       21 Marin          28 Napa       35 San Benito 42 Santa Barbara   49 Sonoma        56 Ventura

                                                               STATE USE ONLY
           RESULT CODE                                        ENTITY NAME                       ENTITY ID NUMBER CIC DATE         DATE ENTERED
  No CIC of FLE- 
Reporting a CIC (33):
 Change in Control (77):
 Exclusion Applies (88):
 No Change in Control (99):
Comments:

BOE-100-B (S2B) REV. 26 (8-23)                                                                         STATE OF CALIFORNIA
                                                                                          BOARD OF EQUALIZATION
                               SCHEDULE B: CHANGE IN OWNERSHIP OF A LEGAL ENTITY
                                     Cumulative Transfers of Original Co-owners’ Interests
                                            (Pursuant to California R&TC section 64(d))

•         If you answered “yes” to both parts of question 3 on the certification page (S1F), complete this schedule; however,
•         If you answered “yes” to both parts of questions 2 and 3 on the certification page (S1F), you are required to complete both 
          Schedule A and Schedule B.
Please answer ALL of the items below.
1. Creation of Original Co-owner Status:
Provide the date(s) and a description of the transaction(s) in which the interest(s) in California real property(ies) was transferred into 
the filing legal entity that was previously excluded from reassessment under R&TC section 62(a)(2) which created the original  
co-owners’ status. Provide the names of the original co-owners and their percentages of interests held in the filing legal entity.

DATE(S) OF TRANSFER(S)                        DESCRIPTION OF TRANSFER(S)

2.  Real Property Schedule: 
Please list all interests in California real property that were previously excluded from reassessment pursuant to R&TC  
section 62(a)(2).
a. Property Owned by Legal Entity

             NAME OF OWNER                    LOCATION                                              ASSESSOR’S PARCEL          CO. NO.
                                              (STREET ADDRESS/ CITY)                                   NUMBER

COUNTY IDENTIFICATION NUMBERS (CO. NO.) (PROVIDED FOR PROPERTY SCHEDULE ABOVE)
01 Alameda                     16 Kings       31 Placer                                   46 Sierra
02 Alpine                      17 Lake        32 Plumas                                   47 Siskiyou
03 Amador                      18 Lassen      33 Riverside                                48 Solang
04 Butte                       19 Los Angeles 34 Sacramento                               49 Sonoma
05 Calaveras                   20 Madera      35 San Benito                               50 Stanislaus
06 Colusa                      21 Marin       36 San Bernardino                           51 Sutter
07 Contra Costa                22 Mariposa    37 San Diego                                52 Tehama
08 Del Norte                   23 Mendocino   38 San Francisco                            53 Trinity
09 El Dorado                   24 Merced      39 San Joaquin                              54 Tulare
10 Fresno                      25 Modoc       40 San Luis Obispo                          55 Tuolumne
11 Glenn                       26 Mono        41 San Mateo                                56 Ventura
12 Humboldt                    27 Monterey    42 Santa Barbara                            57 Yolo
13 Imperial                    28 Napa        43 Santa Clara                              58 Yuba
14 Inyo                        29 Nevada      44 Sana Cruz
15 Kern                        30 Orange      45 Shasta

BOE-100-B (S3F) REV. 26 (8-23)                                                                             STATE OF CALIFORNIA
                                                                                                  BOARD OF EQUALIZATION
                                                          Schedule B continued
3. Cumulative Transfer of Original Co-Owners’ Interests:
a.  Provide a detailed description of the transfer(s) that cumulatively result in a transfer of more than 50 percent of the original  
    co-owners’ interests in the filing legal entity since the date noted in question 1 on Schedule B (S3F). In the description include 
    the date(s) of transfer(s), from which original co-owner(s), the percentage of interests transferred, and to whom the interests were 
    transferred to.

b.  Identify the date(s) of transfer of original co-owner(s)’ interests, the name(s) of the original co-owner(s), the percentage(s) of 
    interests transferred, the name(s) of the current owner(s) after the transfer, and their percentage(s) of interests held after the 
    transfer. Note: If any interests are held by a trust, indicate whether the trust is revocable or irrevocable, identify the beneficiary(ies) 
    of the trust, and identify the percentage of interests the beneficiary(ies) held in the trust.
DATE(S) OF                     DESCRIPTION OF TRANSFER(S)             % INTERESTS NAME OF CURRENT OWNER(S)             %INTERESTS 
TRANSFER(S)                                                           TRANSFERRED                                                     HELD

                                       TOTAL MUST EQUAL THAN 50%                                  TOTAL MUST EQUAL 100%

4.  Transfer Information:  Complete all statements as they pertain to ownership interest of a legal entity(ies); not transfer of real 
YES    NO                  property interests.
           a.  This transfer was solely between spouses or registered domestic partners. If transfer was due to death, provide date of 
              death: 
           b.  This transfer of ownership interests was between parties (for example, a transfer into or out of a legal entity or a transfer 
              between legal entities) in which the proportional ownership interests of the transferor(s) and transferee(s) remain exactly 
              the same before and after the transfer.
If you answered “yes” to item b listed above, you must attach additional documentation (see page 4 of the Instructions for documentation required).

                                                          STATE USE ONLY
          RESULT CODE                                     ENTITY NAME             ENTITY ID NUMBER CIO DATE DATE ENTERED
 Change in Ownership (66):
 Exclusion Applies (88):
 No Change in Control (99):
Comments:

                                                          CLEAR       PRINT

BOE-100-B (S3B) REV. 26 (8-23)                                                              STATE OF CALIFORNIA
                                                                                            BOARD OF EQUALIZATION

                                         IMPORTANT NOTICE
Filing Requirement - Change in Control 
Revenue and Taxation Code section 480.1
The law requires any person or legal entity acquiring ownership control in any corporation, partnership, limited liability company, 
or other legal entity owning real property in California subject to local property taxation to complete and file a change in ownership 
statement with the State Board of Equalization at its office in Sacramento. The change in ownership statement must be filed within 90 
days from the date of the change in control of a corporation, partnership, limited liability company, or other legal entity. The law further 
requires that a change in ownership statement be completed and filed whenever a written request is made therefor by the State Board 
of Equalization, regardless of whether a change in control of the legal entity has occurred.
The failure to file a change in ownership statement within 90 days from the earlier of the date of the change in control of the 
corporation, partnership, limited liability company, or other legal entity, or the date of a written request by the State Board of 
Equalization results in a penalty of 10 percent of the taxes applicable to the new base year value reflecting the change in control of the 
real property owned by the corporation, partnership, limited liability company, or legal entity (or 10 percent of the current year’s taxes 
on that property if no change in control occurred). 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. 

                                         IMPORTANT NOTICE
Filing Requirement - Change in Ownership 
Revenue and Taxation Code section 480.2
The law requires any corporation, partnership, limited liability company, or other legal entity owning real property in California subject 
to local property taxation and transferring shares or other ownership interest in such legal entity which constitutes a change in 
ownership pursuant to subdivision (d) of section 64 of the Revenue and Taxation Code to complete and file a change in ownership 
statement with the State Board of Equalization at its office in Sacramento. The change in ownership statement must be filed within 
90 days from the date that shares or other ownership interests representing cumulatively more than 50 percent of the total control or 
ownership interests in the entity are transferred by any of the original co-owners in one or more transactions. The law further requires 
that a change in ownership statement be completed and filed whenever a written request is made therefor by the State Board of 
Equalization, regardless of whether a change in ownership of the legal entity has occurred.
The failure to file a change in ownership statement within 90 days from the earlier of the date of the change in ownership of the 
corporation, partnership, limited liability company, or other legal entity, or the date of a written request by the Board of Equalization 
results in a penalty of 10 percent of the taxes applicable to the new base year value reflecting the change in ownership of the real 
property owned by the corporation, partnership, limited liability company, or legal entity (or 10 percent of the current year’s taxes on 
that real property if no change in ownership occurred). 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.