MARK CHURCH
EF-262-AH-R09-0515-41000827-1                                                                                        Assessor - County Clerk - Recorder
BOE-262-AH (P1) REV. 0 9(05-15)                                                                                      555 County Center
                                                                                                                     Redwood City, CA 94063
CHURCH EXEMPTION                                                                                                     P 650.363.4500    F 650.599.7435
PROPERTY USED SOLELY FOR RELIGIOUS WORSHIP                                                                           email assessor@smcacre.org
                                                                                                                     web www.smcacre.org
           This claim is filed for fiscal year 20____ - 20____.
           (Example: a person filing a timely claim in January 2011 would 
           enter "2011-2012.")
           NAME AND MAILING ADDRESS
           (Make necessary corrections to the printed name and mailing address)
                                                                                                                                     FOR ASSESSOR’S USE ONLY
                                                                                                                             Received
                                                                                                                             Approved
                                                                                                                             Denied
                                                                                                                             Reason for denial

                  To receive the full exemption, this claim must be filed with the Assessor by February 15.
   Check here if you no longer seek an exemption at this location. Sign and return this form to the Assessor.
NAME OF CHURCH, ORGANIZATION, ETC.

WEBSITE ADDRESS (IF ANY)

MAILING ADDRESS (NUMBER AND STREET/P. O. BOX)

CITY, STATE, ZIP CODE

ADDRESS OF PROPERTY (NUMBER AND STREET)                                                                                 ASSESSOR’S PARCEL NUMBER

CITY, COUNTY, ZIP CODE                                                                                                  DATE PROPERTY WAS FIRST USED BY CLAIMANT

1. Owner and operator: (check applicable boxes)
Claimant is:                 Owner and operator Owner only                             Operator only
   and claims exemption on all     Land          Buildings and improvements                          and/or             Personal property
2. Are all buildings and equipment claimed as exempt used solely for religious worship, including any building in the course of construction?
    Yes          No  
3.Is the land claimed as exempt required for the convenient use of these buildings?                          Yes         No  
4. Is all real property used by the church upon which exemption is claimed for parking purposes necessarily and reasonably required for the
parking of automobiles of persons attending or engaged in religious worship or religious activity, and which is not at other times used for
commercial purposes?
    Yes          No  
   Commercial purposes does not include the parking of vehicles or bicycles, the revenue of which does not exceed the ordinary and necessary 
   costs of operating and maintaining the property for parking purposes. Leased property used for parking purposes is eligible for exemption only 
   if the congregation of the church, religious congregation, or sect is no greater than 500 members.
5. List all uses of the property:

6.a. Is an elementary school and/or secondary school being operated at this location?
    Yes          No  
b. Is a children’s day care center being operated at this location (a children’s day care center includes licensed nursery schools, preschools,
   and infant care centers)?
    Yes          No  
Note: If the answer is YES to a. or b. above, the property is not eligible for the Church Exemption. If the property is both owned and operated by the 
church and used for religious worship, preschool purposes, nursery school purposes, kindergarten purposes, school purposes of less than collegiate 
grade (grades 1 - 12), or for the purposes of both schools of collegiate grade and schools of less than collegiate grade, the claimant may qualify for the 
Religious Exemption. The Religious Exemption has a  one-time"                  filing  provision"and should be filed by February 15; contact the Assessor. The 
claimant may wish instead to annually file by February 15 for the Welfare Exemption.
                                   THIS DOCUMENT IS SUBJECT TO PUBLIC INSPECTION

EF-262-AH-R09-0515-41000827-2
BOE-262-AH (P2) REV. 09 (05-15)
7.Is the real property listed on this claim owned by the church?  Yes       No   If NO, state the name and address of owner:
 OWNER NAME

 MAILING ADDRESS (NUMBER AND STREET/P. O. BOX)                                      CITY, STATE, ZIP CODE

8.Is leased property, if any, used by the church for parking purposes?
      Yes        No   If YES, is the congregation of the church, religious denomination, or sect greater than 500 members?
                         Yes    No  If YES, the property, or portion thereof, so used is not eligible for exemption.
 Note: The benefit of a property tax exemption must inure to the church; if the lease or rental agreement does not specifically provide 
 that the church exemption is taken into account in fixing the terms of agreement, the church shall receive a reduction in rental 
 payments, or a refund of such payments, if paid, for each month of occupancy (or use), or portion thereof, during the fiscal year equal to  
 one-twelfth of the property taxes not paid during such fiscal year by reason of the Church Exemption.
9.Are bingo games being operated on this property? If YES, a claim for the Welfare Exemption must be filed with the Assessor by February 15
each year for the property, or portion of the property so used, to be exempt.  Yes   No  
10.Is any portion of this property being used for living quarters for any person? If YES, describe that portion:           Yes   No  

Note: Living quarters are not eligible for the Church or Religious Exemptions. Certain living quarters may be exempt under the Welfare 
Exemption. Contact the Assessor.
11.Is any portion of this property vacant and/or unused?  Yes          No  
 If YES, describe that portion:
12. Has any portion of this property been rented to, leased to, or been used and/or operated by some person or organization other than the claimant
 since 12:01 a.m., January 1 last year?  Yes      No  
 a.  If property is leased to another church, provide the name and mailing address:
 CHURCH NAME

 MAILING ADDRESS (NUMBER AND STREET/P. O. BOX)                                      CITY, STATE, ZIP CODE

 b. If property is leased to an organization other than a church, provide the name, type of organization and frequency of use; attach additional
     sheets if necessary.
 NAME                                                                               TYPE                                             FREQUENCY

 NAME                                                                               TYPE                                             FREQUENCY

Note: Property used by others (except for worship only) is not eligible for the Church Exemption. It may be exempt if the claimant (owner) and 
the user/operator both file a claim for the Welfare Exemption. Contact the Assessor.
13. Has there been any change in the use of the property or any construction commenced and/or completed on this property
 since 12:01 a.m., January 1 last year?  Yes      No   If YES, describe:

14.Is any equipment or other property at this location being leased or rented from someone else?
      Yes        No   If YES, list the name and address of the owner and the type, make, model, and serial number of the property. If the property 
                        listed is not used exclusively for religious worship, please state the other uses of the property (attach schedule as necessary):

                               Whom should we contact during normal business hours for additional information?
NAME                                                                                                       TITLE

DAYTIME TELEPHONE                   EMAIL ADDRESS
(       )
                                                         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 OF PERSON MAKING CLAIM                                                                      TITLE
t
NAME OF PERSON MAKING CLAIM                                                                           DATE