MARK CHURCH
EF-263-C-R02-0611-41000391-1                                                              Assessor - County Clerk - Recorder
BOE-263-C (P1) REV. 02 (06-11)                                                            555 County Center
                                                                                          Redwood City, CA 94063
CHURCH LESSORS’ EXEMPTION CLAIM                                                           P 650.363.4500    F 650.599.7435
PROPERTY LEASED BY A CHURCH TO A PUBLIC                                                   email assessor@smcacre.org
                                                                                          web www.smcacre.org
SCHOOL, COMMUNITY COLLEGE, STATE COLLEGE, OR 
STATE UNIVERSITY, INCLUDING THE UNIVERSITY OF 
CALIFORNIA, USED JOINTLY WITH A CHURCH
       NAME AND MAILING ADDRESS
       (Make necessary corrections to the printed name and mailing address)

                                                                                          To receive the full exemption, this claim must 
                                                                                          be filed with the Assessor by February 15.

IDENTIFICATION OF APPLICANT
LESSOR’S CHURCH 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(S)                INCIDENTAL USE
   Land
   Buildings and Improvements
   Personal Property
NAME OF QUALIFYING PUBLIC SCHOOL INSTITUTION

MAILING ADDRESS                                                                           CITY, STATE, ZIP CODE

  Yes   No    The total income received by the church in the form of rents, fees, or charges from the lease does not exceed the ordinary 
              and usual expenses in maintaining and operating the leased property. 
       An affidavit must be attached in which the lessee declares it uses the property for exempt purposes.
                                                                           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-C-R02-0611-41000391-2
BOE-263-C (P2) REV. 02 (06-11)

                              INSTRUCTIONS FOR FILING CHURCH LESSORS’ EXEMPTION CLAIM

IMPORTANT NOTICE
This  claim  may be  filed  to  claim the  welfare  exemption on property  leased by  a  church  to a public  school, 
community college, state college, state university, including the University of California when the church and 
public school or college both use the property in a joint manner. (See Revenue and Taxation Code section 214.6.)

Although the church has previously been granted the religious exemption, which only requires a one-time filing, 
annual filing of this claim form is required for a property used in conjunction with a public school to be granted 
the welfare exemption.

Failure to submit the public school or college lessee’s affidavit will result in denial of the exemption for the lessor. 
Submission of the lessee’s affidavit after the date the lessors’ claim form is due will result in a portion of the 
exemption being denied. A sample affidavit is included as page 3 of this form.

IDENTIFICATION OF APPLICANT
Enter your church, corporate or organization information.

IDENTIFICATION OF PROPERTY
Enter the address of the property for which you are seeking exemption. 

FISCAL YEAR
The fiscal year for which an exemption is sought must be entered correctly. The proper fiscal year follows the lien 
date (12:01 a.m., January 1) as of which the taxable or exempt status of the property is determined. For example, 
a person filing a timely claim in February 2011 would enter “2011-2012” on line four of the claim; a “2010-2011” 
entry on a claim filed in February 2011 would signify that a late claim was being filed for the preceding fiscal year.

USES OF PROPERTY
Check each of the types of property being claimed, and state the primary and incidental uses of the property. 
Primary use may include both church and school use; incidental uses would include others who use the property 
for meetings, receptions, etc. 

Enter the name and address of the public school or college lessee. If additional space is required, or if more than 
one lessee is being listed, attach an itemized list.

Check the appropriate box to affirm that the total income received by the church in the form of rents, fees, or 
charges from the lease does not exceed the ordinary and usual expenses in maintaining and operating the leased 
property. The exemption is not available if the income exceeds the ordinary and usual expenses in maintaining 
and operating the leased property.

Attach an affidavit in which the public school or college lessee declares it uses the property for exempt purposes.

If the property, or a portion thereof, for which exemption is claimed is a student bookstore that generates unrelated 
business taxable income as defined in section 512 of the Internal Revenue Code, property taxes are determined 
by establishing a ratio of the unrelated business taxable income to the bookstore’s gross income.

EF-263-C-R02-0611-41000391-3
BOE-263-C (P3) REV. 02 (06-11)
RETURN THIS 
AFFIDAVIT TO 
LESSOR
                              AFFIDAVIT FOR EXECUTION BY QUALIFYING PUBLIC SCHOOL LESSEES

NAME OF QUALIFYING PUBLIC SCHOOL LESSEE

MAILING ADDRESS

CITY, STATE, ZIP CODE

R Check the type of qualifying use of the property
       PUBLIC SCHOOL                              STATE UNIVERSITY
       COMMUNITY COLLEGE                          UNIVERSITY OF CALIFORNIA
       STATE COLLEGE
NAME OF CHURCH

MAILING ADDRESS

CITY, STATE, ZIP CODE

DATE LEASE SIGNED                                                           COMMENCEMENT DATE OF LEASE

                                 THE ASSESSOR MAY REQUEST 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     With respect to lessees that are political subdivisions of the state, the property is located within the boundaries of the 
              exempt government entity leasing the same.
 Yes   No     The property, or a portion thereof, is a student bookstore that generates unrelated business taxable income as defined in 
              section 512 of the Internal Revenue Code.
              If Yes, a copy of the institution’s most recent tax return filed with the Internal Revenue Service must accompany this 
              affidavit. Property taxes are determined by establishing a ratio of the unrelated business taxable income to the bookstore’s 
              gross income.
                                                       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