MARK CHURCH
EF-63-R04-0518-41000430-1                                               Assessor - County Clerk - Recorder
BOE-63 (FRONT) REV.   (4 05 1- 8)                                       555 County Center
DISABLED PERSONS CLAIM FOR                                              Redwood City, CA 94063
EXCLUSION OF NEW CONSTRUCTION                                           P 650.363.4500    F 650.599.7435
FOR OCCUPIED DWELLING                                                   email assessor@smcacre.org
                                                                        web www.smcacre.org
This claim is for the exclusion from reassessment of any 
construction to make an existing dwelling more accessible 
to a severely and permanently disabled person who is
a  permanent  resident  of  the  dwelling.  Only  construction 
completed on or after June 6, 1990 is eligible. The
exclusion does not apply to accessibility improvements
and features that are usual or customary for comparable 
properties not occupied by disabled persons.
                 TO BE COMPLETED BY THE CLAIMANT (DISABLED PERSON, SPOUSE OR LEGAL GUARDIAN)
PRINT NAME OF CLAIMANT                                               PRINT NAME OF DISABLED PERSON (if different)

ADDRESS OF PROPERTY WITH NEW CONSTRUCTION                            ASSESSOR’S PARCEL NUMBER

DESCRIBE THE IMPROVEMENTS MADE

DATE CONSTRUCTION COMPLETED

                                            CERTIFICATION
I certify (or declare) under penalty of perjury under the laws of the State of California that the disabled person named above permanently 
  resides at the property address and that the construction was to make the residence more accessible to the disabled person.
CLAIMANT’S SIGNATURE                                             DAYTIME PHONE NUMBER                            DATE
W                                                                (   )
E-MAIL ADDRESS

                                            TO BE COMPLETED BY PHYSICIAN

The claimant named above is applying to have a portion or all of the construction, installation or modifi cation of a dwelling excluded from 
reappraisal because it makes the dwelling more accessible to a severely and permanent disabled person. For purposes of this tax benefi t, 
the law defi nes a severely and permanently disabled person as any person who has a physical disability or impairment which affects sight, 
speech, hearing, or the use of any limbs and which results in a functional limitation as to employment or substantially limits one or more 
major life activity of that person, and which has been diagnosed as permanently affecting the person’s ability to function.
NAME OF DISABLED PERSON (please print)

PLEASE IDENTIFY THE SPECIFIC DISABILITY-RELATED REQUIREMENTS NECESSITATING ACCESSIBILITY IMPROVEMENTS OR FEATURES

I am a licensed         Physician       Surgeon  My specialty is 

                                            DECLARATION
  I declare that the disabled person named above is severely and permanently disabled according to the defi nition 
  above and that the construction, installation or modifi cation makes the dwelling more accessible to that person.
PHYSICIAN’S SIGNATURE                                            DATE
W
PHYSICIAN’S NAME (print or type)                                 PHYSICIAN’S PHONE NUMBER
                                                                 (   )

EF-63-R04-0518-41000430-2
BOE-63 (BACK) REV.   (4 05 1- 8)

                                      GENERAL INFORMATION

California law provides that certain construction, installations, or modifi cations of existing single- or multiple-
family dwellings can be excluded from increases in property taxation if the work is performed to make the 
dwelling more accessible to a severely and permanently disabled person who is a permanent resident of the 
dwelling. This exclusion does not apply to accessibility improvements and features that are usual or customary 
for comparable properties not occupied by disabled persons, but will apply only to those improvements or 
features that specifi cally adapt a dwelling for accessibility by a severely disabled person.
Revenue and Taxation Code section 74.3(b) defi nes a severely and permanently disabled person as any 
person who has a physical disability or impairment, whether from birth or by reason of accident or disease, 
including but not limited to any disability or impairment which affects sight, speech, hearing, or use of any 
limbs and which results in a functional limitation as to employment or substantially limits one or more major 
life activity of that person, and which has been diagnosed as permanently affecting the person’s ability to 
function.
To qualify for this exclusion:
                      •     The construction, installations, or modifi cations must be completed on or after June 6, 1990;
                      •     The disabled person must be a permanent resident (not necessarily the owner) of the dwelling;
                            and
                      •     The dwelling must be occupied by the owner and therefore eligible for the homeowners’
                            exemption.
To claim the exclusion, the disabled person, his or her spouse, or legal guardian must submit to the Assessor 
the following:
                      •     A statement signed by a licensed physician or surgeon of appropriate specialty which certifi es that
                            the person is severely and permanently disabled as defi ned above. The statement must identify
                            specifi c disability-related requirements necessitating accessibility improvements or features, and
                      •     A statement that identifi es the construction, installation, or modifi cation that was in fact necessary
                            to make the structure more accessible to the disabled person.
The Assessor may charge a fee to the disabled person or his or her spouse or legal guardian suffi cient to 
reimburse the Assessor for the costs of processing and administering the statement.