MARK CHURCH
EF-502-A-R14-0518-41005969-1                                                                       Assessor - County Clerk - Recorder
BOE-502-A (P1) REV. 1 4(05-18)                                                                     555 County Center
PRELIMINARY CHANGE OF OWNERSHIP REPORT                                                             Redwood City, CA 94063
T                                                                                                  P 650.363.4500    F 650.599.7435
                                                                                                   email assessor@smcacre.org
                  Preliminary  Change  of  Ownership  Report                                       web www.smcacre.org
  filed with each conveyance in the County Recorder’s office 
for the county where the property is located.
                    NAME AND MAILING ADDRESS OF BUYER/TRANSFEREE                         ASSESSOR'SPARCELNUMBER
                    (Make necessary corrections to the printed name and mailing address
                                                                                         SELLER/TRANSFEROR

                                                                                         BUYER’SDAYTIMETELEPHONENUMBER
                                                                                         (        )
                                                                                         BUYER’SEMAILADDRESS

STREETADDRESSORPHYSICALLOCATIONOFREALPROPERTY

                                                                                                                      MO        DAY   YEAR
  YES          NO   Thispropertyisintendedasmyprincipalresidence.IfYES,pleaseindicatethedateofoccupancy
                    orintendedoccupancy.
  YES          NO   Areyouadisabledveteranoraunmarriedsurvivingspouseofadisabledveteranwhowas
                    compensatedat100%bytheDepartmentofVeteransAffairs?
MAILPROPERTYTAXINFORMATIONTO(NAME)

MAILPROPERTYTAXINFORMATIONTO(ADDRESS)                                                    CITY                                   STATE ZIPCODE

PART 1. TRANSFER INFORMATION                     Please complete all statements.
  YES NO                                                                                                            
           A. Thistransferissolelybetweenspouses (addition or removal of a spouse, death of a spouse, divorce settlement, etc.).
           B. ThistransferissolelybetweendomesticpartnerscurrentlyregisteredwiththeCaliforniaSecretaryofState (addition or removal of
               a partner, death of a partner, termination settlement, etc.).
          * C. Thisisatransfer:    between parent(s) and child(ren)                      from grandparent(s) to grandchild(ren).
          * This      transferistheresultofacotenant’sdeath. Dateofd
          * E. This transaction is to replace a principal residence owned by a person 55 years of age or older.
               Withinthesamecounty?          YES     NO
          * F. ThistransactionistoreplaceaprincipalresidencebyapersonwhoisseverelydisabledasdefinedbyRevenueandTaxationCode
               section69.5.Withinthesamecounty?              YES                       NO
           G. This transaction is only a correction of the name(s) of the person(s) holding title to the property (e.g., a name change upon marriage).
               IfYES,pleaseexplain:
           H. Therecordeddocumentcreates,terminates,orreconveysalender'sinterestintheproperty.
           I. This transaction is recorded only as a requirement for financing purposes or to create, terminate, or reconvey a security interest
               (e.g., cosigner).IfYES,pleaseexplain:
           J. Therecordeddocumentsubstitutesatrusteeofatrust,mortgage,orothersimilardocument.
           K. Thisisatransferofproperty:
               1. to/fromarevocabletrustthatmayberevokedbythetransferorandisforthebenefitof
                       thetransferor,and/or  thetransferor'sspouse                       registereddomesticpartner.
               2. to/fromanirrevocabletrustforthebenefitofthe
                       creator/grantor/trustorand/or grantor's/trustor’s                 grantor’s/trustor’s       registereddomesticpartner.
           L. Thispropertyissubjecttoaleasewitharemainingleasetermof35yearsormoreincludingwrittenoptions.
           M. This is a transfer between parties in which proportional interests of the transferor(s) and transferee(s) in each and every parcel

               requir

          * O. Thistransferistothefirstpurchaserofanewbuildingcontaininganactivesolarenergysystem.
           P. Other.Thistransferisto
          *
               Please provide any other information that will help the Assessor understand the nature of the transfer.
                               THIS DOCUMENT IS NOT SUBJECT TO PUBLIC INSPECTION

EF-502-A-R14-0518-41005969-2
BOE-502-A (P2) REV. 1 4(05-18)
PART 2. OTHER TRANSFER INFORMATION                                     Check and complete as applicable.
A. Dateoftransfer,ifotherthanrecordingdate:
B. Typeoftransfer:
   Purchase               Foreclosure       Gift     Tradeorexchange            Merger,stock,orpartnershipacquisition(FormBOE-100-B)
   Contractofsale.Dateof                                                                     Inheritance.Dateofdeath:
   Sale/leaseback             Creationofalease       Assignment of a lease        Terminationofalease.Dateleasebegan:
                              Original term in years (including written options):  Remaining term in years (including written options):
   Other.Pleaseexplain:
C. Onlyapartialinterestinthepropertywastransferred.  YES            NO            IfYES,indicatethepercentagetransferred:              %
PART 3. PURCHASE PRICE AND TERMS OF SALE                               Check and complete as applicable.
A. Totalpurchaseprice                                                                                                $_______________
B. Cashdownpaymentorvalueoftradeorexchangeexcludingclosingcosts                                                 Amount$_______________
C. Firstdeedoftrust@______%interestfor______years.            Monthlypayment$_____________                      Amount$_______________
   FHA(___DiscountPoints)                 Cal-Vet    VA(___DiscountPoints)         Fixedrate       Variable rate
   Bank/Savings&Loan/CreditUnion                 Loancarriedbyseller
   Balloonpayment$_____________                   Duedate:_____________
D. Seconddeedoftrust@______%interestfor______years.Monthlypayment$_____________                                 Amount$_______________
   Fixedrate                Variable rate   Bank/Savings&Loan/CreditUnion          Loancarriedbyseller
   Balloonpayment$_____________                   Duedate:_____________
E. WasanImprovementBondorotherpublicfinancingassumedbythebuyer?                   YES       NO     Outstandingbalance$_______________
F. Amount,ifany,ofrealestatecommissionfeespaidbythebuyerwhicharenotincludedinthepurchaseprice                    $_______________
G. Thepropertywaspurchased:          Throughrealestatebroker.Brokername:                           Phonenumber:  (        )
   Direct from seller          From a family member-Relationship 
   Other.Pleaseexplain:
H. Pleaseexplainanyspecialterms,sellerconcessions,broker/agentfeeswaived,financing,andanyotherinformation(e.g.,buyerassumedthe
   existingloanbalance)thatwouldassisttheAssessorinthevaluationofyourproperty.

PART 4. PROPERTY INFORMATION                                           Check and complete as applicable.
A. Type of property transferred
   Single-family residence                                                      Co-op/Own-your-own              Manufacturedhome
   Multiple-familyresidence.Numberofunits:                                      Condominium                     Unimprovedlot
   Other.Description:(i.e.,timber,mineral,waterrights,etc.)                     Timeshare                       Commercial/Industrial

B. YES         NO Personal/businessproperty,orincentives,providedbysellertobuyerareincludedinthepurchaseprice.Examplesofpersonal
                    propertyarefurniture,farmequipment,machinery,etc.Examplesofincentivesareclubmemberships,etc.Attachlistifavailable.
   IfYES,enterthevalueofthepersonal/businessproperty:                  $                           Incentives   $
C. YES         NO Amanufacturedhomeisincludedinthepurchaseprice.
   IfYES,enterthevalueattributedtothemanufacturedhome:                          $
   YES         NO Themanufacturedhomeissubjecttolocalpropertytax.IfNO,enterdecalnumber:
D. YES         NO Thepropertyproducesrentalorotherincome.
   IfYES,theincomeisfrom:            Lease/rent      Contract       Mineral rights          Other:
E. Theconditionofthepropertyatthetimeofsalewas:      Good                         Average   Fair           Poor
Pleasedescribe:__________________________________________________________________________________________________
                                                     CERTIFICATION
I certify (or declare) 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. 
SIGNATUREt OF BUYER/TRANSFEREE OR CORPORATE OFFICER                               DATE                          TELEPHONE
                                                                                                                (        )
NAME OF BUYER/TRANSFEREE/PERSONALREPRESENTATIVE/CORPORATE OFFICER (PLEASE PRINT) TITLE                          EMAILADDRESS

                            Assessor’

EF-502-A-R14-0518-41005969-3
BOE-502-A (P3) REV. 1 4(05-18)
                                         INFORMATION

Preliminary Change of Ownership Report
NOTICE

                              You may be responsible for the current or upcoming property taxes even if you do not receive the tax 
bill.

       location of the real property.
NOTE:  Your telephone number and/or email address is very important. If there is a question or a problem, the Assessor 
needs to be able to contact you.

                              T

                                                                                    A claim form must be filed a nd all 
requirements met in order to obtain the exemption. Please contact the Assessor for a claim form.
PART 1:  TRANSFER INFORMATION
If you check YES to any of these statements, the Assessor may ask for supporting documentation.
C, D, E, F:
base. A claim form must be filed and all requirements met in order to obtain any of 
these exclusions. 
Y

G:

H:
in the property.
      "Beneficial interest"

I: A "cosigner"

M:
exactly the same.
N:                            this property is subject to a government or nonprofit affordable housing program that imposes restrictions.
P
O:                                                                          A claim form must be filed and all requirements 
met in order to obtain the exclusion. Contact the Assessor for a claim form.
PART 2:  OTHER TRANSFER INFORMATION
A:

B:
sheet if necessary.
C.                                                                                              Change in Ownership
Statement, Death of Real Property Owner, 

EF-502-A-R14-0518-41005969-4
                   4 5-18)
PART 3: PURCHASE PRICE AND TERMS OF SALE

                                                                      Y

A. 

        “Mortgage insurance”insuramortgagor’FHA
        .

B. costs.
        “Closing costs”      propertyseller
        ’

C. T
        A “balloon payment” paid
        installment. 

D. T

E.balance,

        An   “improvement bond or other public financing”

F.

G.  broker broker’numberthe
   the
“Direct from sellerfamilywho”
purchaproperty                     “From a family member” fatheraunt,
                                                                                       “OTHER”and
provide a detailed description (attach a separate sheet if necessary).

H. unrecorde propertyconcession(e.g.,
      the
 in
.
PART 4: PROPERTY INFORMATION
A.
B. businebusiness
 machinery tickets,
homeowners’ not
provided.
C.    attributable
  Vbeing
.
D.source
geneowner-occupied.
E.                                                                    “fair ”or “poor”a
brief description of repair needed.