MARK CHURCH
EF-263-A-R07-0617-41000404-1                                                               Assessor - County Clerk - Recorder
BOE-263-A (P1) REV. 0 7(06-17)                                                             555 County Center, 3rd Floor
                                                                                           Redwood City, CA 94063
QUALIFIED LESSORS’ EXEMPTION CLAIM                                                         P 650.363.4501    F 650.599.7456
                                                                                           email ppdutyauditor@smcacre.org
PROPERTY USED FOR FREE PUBLIC LIBRARIES AND FREE                                           web www.smcacre.org
MUSEUMS AND USED EXCLUSIVELY FOR PUBLIC SCHOOLS, 
COMMUNITY COLLEGES, STATE COLLEGES, STATE UNIVERSITIES, 
UNIVERSITY OF CALIFORNIA, AND NONPROFIT COLLEGES 
          NAME AND MAILING ADDRESS
          (Make necessary corrections to the printed name and mailing address)

                                                                                           To receive one time reporting treatment 
                                                                                           for the exemption, this claim must be filed 
                                                                                           with the Assessor within 120 days of the 
                                                                                           commencement date of the lease.
IDENTIFICATION OF APPLICANT
LESSOR’S CORPORATE OR ORGANIZATION NAME

MAILING ADDRESS

CITY, STATE, ZIP CODE

CORPORATE ID (IF ANY)

IDENTIFICATION OF PROPERTY 
ADDRESS OF PROPERTY (NUMBER AND STREET)                                                                                      FISCAL YEAR OF CLAIM
                                                                                                                             20___ –          20___
CITY, COUNTY, ZIP CODE                                                                                    ASSESSOR’S PARCEL NUMBER

USE OF PROPERTY              R Check and state the primary and incidental qualifying uses of the property.
The exemption claim is made for the following property:   (if there are numerous properties, please attach a list that clearly identifies the 
                                                          property and the name and address of the lessee)
                    PROPERTY TYPE                                             PRIMARY USE                       INCIDENTAL USE
           Land
           Buildings and Improvements
           Personal Property

 Yes            No  The lease confers upon the lessee the exclusive right to possession and use of the property.

 Yes            No  As used herein a qualifying institution is one whose property qualifies for the free public library, free museum, public school, 
                    community college, state college, state university, University of California, or nonprofit college property tax exemption.
 Yes            No  The lessee institution has the option at the end of the lease term of acquiring the above property described in the lease for $1 
                    (one dollar) or any other nominal sum.
Important: A lessee’s affidavit, in which the lessee attests to the above statement(s) is provided. Failure to submit/complete the lessee’s affidavit 
will result in denial of one time reporting treatment for the exemption. A separate affidavit is required of each lessee.
                                                                              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 and correct to the best of my knowledge and belief.
SIGNATURE OF PERSON MAKING CLAIM                                                                          DATE
t
NAME OF PERSON MAKING CLAIM                                                                               TITLE

EMAIL ADDRESS                                                                                             DAYTIME TELEPHONE
                                                                                                          ( )
                                     THIS DOCUMENT IS SUBJECT TO PUBLIC INSPECTION

EF-263-A-R07-0617-41000404-2
BOE-263-A (P2) REV. 07 (06-17)
RETURN THIS 
AFFIDAVIT TO 
LESSOR
                              AFFIDAVIT FOR EXECUTION BY QUALIFYING INSTITUTIONAL LESSEE
NAME OF QUALIFYING LESSEE INSTITUTION

MAILING ADDRESS

CITY, STATE, ZIP CODE

R Check the type of qualifying use of the property
               FREE PUBLIC LIBRARY                        COMMUNITY COLLEGE     UNIVERSITY OF CALIFORNIA
               FREE MUSEUM                                STATE COLLEGE         NONPROFIT COLLEGE
               PUBLIC SCHOOL                              STATE UNIVERSITY
NAME OF LESSOR

MAILING ADDRESS

CITY, STATE, ZIP CODE

COMMENCEMENT DATE OF LEASE                                DATE PROPERTY PUT TO EXEMPT USE

                                     PLEASE ATTACH A COPY OF THE LEASE AGREEMENT

The following property is leased as of January 1 of this year. If personal property is being leased, indicate the type, make, model, serial number, 
etc. Attach a separate listing if necessary.
 PROPERTY TYPE                                            PROPERTY DESCRIPTION
(REAL OR PERSONAL)

  Yes           No  The lessee institution has the option at the end of the lease term of acquiring the above property described in the lease for $1 
                    (one dollar) or any other nominal sum.

                                                          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 and correct to the best of my knowledge and belief.
SIGNATURE OF PERSON MAKING CLAIM                                                DATE
t
NAME OF PERSON MAKING CLAIM                                                     TITLE

EMAIL ADDRESS                                                                   DAYTIME TELEPHONE
                                                                                ( )
                                 THIS DOCUMENT IS SUBJECT TO PUBLIC INSPECTION