MARK CHURCH
EF-65-PT-R06-0112-41000402-1                                                  Assessor - County Clerk - Recorder
BOE-65-PT (P1) REV. 06 (01-12)                                                555 County Center
CLAIM FOR INTERCOUNTY TRANSFER OF                                             Redwood City, CA 94063
                                                                              P 650.363.4500    F 650.599.7435
BASE YEAR VALUE TO REPLACEMENT PROPERTY                                       email assessor@smcacre.org
FROM PRINCIPAL RESIDENCE DAMAGED OR                                           web www.smcacre.org
DESTROYED IN A GOVERNOR-DECLARED 
DISASTER

A.  REPLACEMENT PROPERTY:
ASSESSOR’S PARCEL NUMBER

PROPERTY ADDRESS                                                              CITY

DATE OF PURCHASE               PURCHASE PRICE                                 RECORDER’S DOCUMENT NUMBER

DATE OF COMPLETION OF NEW CONSTRUCTION                                        COST OF NEW CONSTRUCTION

Is this property your principal place of residence?   Yes  No
B.  ORIGINAL (FORMER) PROPERTY:
ASSESSOR’S PARCEL NUMBER                                                      DATE OF DISASTER

PROPERTY ADDRESS                                             CITY                              COUNTY

Was this property your principal place of residence?  Yes  No

NOTE: You must attach a copy of the original property’s latest tax bill and any supplemental tax bill(s) issued before the date of the 
disaster.
Was there any new construction to the original property between the date of those tax bill(s) and the date of disaster?  Yes                           No
If Yes, please explain:

C.  CLAIMANT INFORMATION
NAME OF CLAIMANT

I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing, and all information 
hereon, is true, correct, and complete to the best of my knowledge and belief.
tSIGNATURE OF CLAIMANT                                                        DATE

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

   All information provided on this claim is subject to verification. If you have any questions about this form, please contact the Assessor’s office. 
                               THIS DOCUMENT IS SUBJECT TO PUBLIC INSPECTION

EF-65-PT-R06-0112-41000402-2
BOE-65-PT (P2) REV. 06 (01-12)
                                       GENERAL INFORMATION

California law allows any individual or individuals who reside in an original property (i.e., principal place of residence) to transfer the 
base year value of the original property that has been substantially damaged of destroyed by a disaster to a replacement property 
(i.e., principal place of residence) of equal or lesser value in another county that has adopted an ordinance allowing such transfers. 
The following requirements must be met:

1. the disaster must be a major misfortune or calamity in an area subsequently proclaimed by the Governor to be in a state of
   disaster as a result of the misfortune or calamity;
2. the replacement property must have been acquired or newly constructed within three years after the date of the disaster
   (including land);
3. a claim for relief must be filed within three years after the replacement property is acquired or newly constructed.

Property is substantially damaged if the land or the improvements sustain physical damage amounting to more than 50 percent of 
its full cash value immediately prior to the disaster.

In general, “equal or lesser value” means the fair market value of a replacement property on the date of purchase or completion 
of construction does not exceed:

1. 105 percent of full cash value or fair market value of the original property immediately prior to the date of disaster if a
   replacement property is purchased or newly constructed within the first year following the date of the damage or destruction
   of the original property;
2. 110 percent of full cash value or fair market value of the original property immediately prior to the date of disaster if a
   replacement property is purchased or newly constructed within the second year following the date of the damage or destruction
   of the original property; or
3. 115 percent of full cash value or fair market value of the original property immediately prior to the date of disaster if a
   replacement property is purchased or newly constructed within the third year following the date of the damage or destruction
   of the original property.

TRANSFERS BETWEEN COUNTIES ARE ALLOWED ONLY IF THE COUNTY IN WHICH THE REPLACEMENT PROPERTY IS 
LOCATED HAS PASSED AN AUTHORIZING ORDINANCE.

The acquisition of an ownership interest in a legal entity that, directly or indirectly, owns real property is not an acquisition of 
replacement property under the law.