MARK CHURCH
EF-268-B-R10-0514-41000773-1                                                                     Assessor - County Clerk - Recorder
BOE-268-B (P1) REV. 10 (05-1 )4                                                                  555 County Center, 3rd Floor
FREE PUBLIC LIBRARY OR FREE MUSEUM CLAIM                                                         Redwood City, CA 94063
                                                                                                 P 650.363.4501    F 650.599.7456
PROPERTY     USED SOLELY FOR EITHER A FREE PUBLIC LIBRARY                                        email ppdutyauditor@smcacre.org
OR FREE MUSEUM.                                                                                  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)

                                                                                             A claimant must complete and file this form 
                                                                                             with the Assessor by February 15.

NAME OF PERSON MAKING CLAIM                                                                      TITLE 

NAME AND ADDRESS OF OWNER OF LAND AND BUILDINGS (if different from above)

NAME OF INSTITUTION

MAILING ADDRESS OF INSTITUTION (CITY, STATE, ZIP CODE)

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

CITY, COUNTY, ZIP CODE                                                                           LEASE TERMINATION DATE

DAYS OF THE WEEK OPEN TO THE PUBLIC AND HOURS OF OPERATION

R Check the type of qualifying exclusive use of the property. If filing for the first  time, attach a copy of the lease or agreement.
   LIBRARY                              MUSEUM
1.  Yes              No  Is admittance to the library or museum free? If no, please explain: 

2. *Yes              No  If a library, is there a user charge for the use of books, periodicals, or facilities? 
3. *Yes              No  If a museum, is there a charge for viewing the museum contents?

                         *If yes, and a BOE-267, Claim for Welfare Exemption, has not been filed for the property, please contact the Assessor’s
                         Office immediately. The deadline for timely filing a Claim for Welfare Exemption is February 15 each year. Where there is a 
                         user charge, a Claim for Welfare Exemption may be allowed if both the organization and the use of the property meet all of 
                         the requirements for the exemption.
4.  Yes              No  Is the property, or a portion thereof, for which the exemption is claimed a 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 claim. 
                         Property taxes as determined by establishing a ratio of the unrelated business taxable income to the bookstore’s gross 
                         income will be levied.
5.  Yes              No      Is any of the owned property used for sales or business purposes other than a bookstore?  If yes, please explain:  

6.  Yes              No  Is any equipment or other property at this location being leased or rented from someone else?

                      If yes, list in the remarks section the name and address of the owner and the type, make, model, and serial number of the 
                      property. "Exclusive use "is not required for this exemption, the lessee’s possession is sufficient evidence of use.

                      The benefit of a property tax exemption must inure to the lessee institution; the lessee may be entitled to claim a refund of 
                      taxes paid by the lessor. See section 202.2 of the Revenue and Taxation Code.
                                        THIS DOCUMENT IS SUBJECT TO PUBLIC INSPECTION

EF-268-B-R10-0514-41000773-2
BOE-268-B (P2) REV. 10 (05-14)
7.List only property that is owned. Leased property may also be exempt if listed under the remarks section below. If leased property is listed, it is
not necessary for the lessor to also claim the exemption on the Lessors’ Exemption Claim. 
                            PROPERTY DESCRIPTION                    STATE PRIMARY AND INCIDENTAL USE OF PROPERTY DESCRIBED
Land: (Legal description or map book, page and parcel number        Primary use:
from most recent tax statement)
                                                                    Incidental use:
Area: (Acres or square feet)

Buildings and Improvements                                          Primary use:
 Bldg. No.             No. of    No. of Type of 
 or Name               Floors    Rooms  Construction

                                                                    Incidental use:

Personal Property: Describe - include cost and acquisition dates if Primary use:
applicable. (Attach a separate sheet if necessary.)
                                                                    Incidental use:

REMARKS

                              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 contained herein, 
          including any accompanying statements or documents, is true, correct, and complete to the best of my knowledge and belief.
NAME OF PERSON MAKING CLAIM                                                               TITLE

SIGNATURE OF PERSON MAKING CLAIM                                                          DATE
t