MARK CHURCH
EF-502-AH-R16-0617-41001186-1                                                                Assessor - County Clerk - Recorder
BOE-502-AH(P1) REV. 1  (06 -17)6                                                             555 County Center
                                                                                             Redwood City, CA 94063
CHANGE OF OWNERSHIP STATEMENT                                                                P 650.363.4500    F 650.599.7435
This statement represents a written request from the Assessor.                               email assessor@smcacre.org
                                                                                             web www.smcacre.org
Failure to file will result in the assessment of a penalty.
FILE THIS STATEMENT BY:______________________
                                 FOR ASSESSOR’S USE ONLY
                                                                                   ASSESSOR'S PARCEL NUMBER

                                                                                   SELLER/TRANSFEROR

                                                                                   BUYER’S DAYTIME TELEPHONE NUMBER 
                                                                                   (        )
                                                                                   BUYER’S EMAIL ADDRESS

STREET ADDRESS OR PHYSICAL LOCATION OF REAL PROPERTY

                                                                                                                       MO       DAY YEAR
YES            NO   This property is intended as my principal residence. If YES, please indicate the date of occupancy 
                    or intended occupancy.
YES            NO   Are you a disabled veteran or a unmarried surviving spouse of a disabled veteran who was  
                    compensated at 100% by the Department of Veterans Affairs?
MAIL PROPERTY TAX INFORMATION TO (NAME)

MAIL PROPERTY TAX INFORMATION TO (ADDRESS)                                         CITY                                   STATE ZIP CODE

PART 1. TRANSFER INFORMATION                         Please complete all statements.
          This section contains possible exclusions from reassessment for certain types of transfers.
YES NO
               A. This transfer is solely between spouses (addition or removal of a spouse, death of a spouse, divorce settlement, etc.).
               B. This transfer is solely between domestic partners currently registered with the California Secretary of State (addition or removal of
               a partner, death of a partner, termination settlement, etc.).
          * C. This is a transfer:     between parent(s) and child(ren)            from grandparent(s) to grandchild(ren).
          * D. This transfer is the result of a cotenant’s death.  Date of death ___________________________
          * E. This transaction is to replace a principal residence owned by a person 55 years of age or older.
               Within the same county?           YES       NO
          * F. This transaction is to replace a principal residence by a person who is severely disabled as defined by Revenue and Taxation Code
               section 69.5. Within the same county?       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).
               If YES, please explain:
               H. The recorded document creates, terminates, or reconveys a lender's interest in the property.
               I. This transaction is recorded only as a requirement for financing purposes or to create, terminate, or reconvey a security interest
               (e.g., cosigner). If YES, please explain:
               J. The recorded document substitutes a trustee of a trust, mortgage, or other similar document.
               K. This is a transfer of property:
               1. to/from a revocable trust that may be revoked by the transferor and is for the benefit of
                           the transferor, and/or        the transferor's spouse     registered domestic partner.
               2. to/from an irrevocable trust for the benefit of the
                           creator/grantor/trustor and/or         grantor's/trustor’s spouse grantor’s/trustor’s registered domestic partner.
               L. This property is subject to a lease with a remaining lease term of 35 years or more including written options.
               M. This is a transfer between parties in which proportional interests of the transferor(s) and transferee(s) in each and every parcel
               being  transferred  remain  exactly  the  same  after  the  transfer.  
               N. This is a transfer subject to subsidized low-income housing requirements with governmentally imposed restrictions, or restrictions 
               imposed by specified nonprofit corporations.
          * O. This transfer is to the first purchaser of a new building containing an active solar energy system.
               P. Other. This transfer is to ____________________________________________________________
          * Please refer to the instructions for Part 1.
               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-AH-R16-0617-41001186-2
BOE-502-A H(P2) REV. 1 6(0 -17)6
PART 2. OTHER TRANSFER INFORMATION                                           Check and complete as applicable.
A. Date of transfer, if other than recording date:
B. Type of transfer:
       Purchase            Foreclosure      Gift       Trade or exchange          Merger, stock, or partnership acquisition (Form BOE-100-B)
       Contract of sale. Date of contract:                                                          Inheritance. Date of death:
       Sale/leaseback           Creation of a lease    Assignment of a lease        Termination of a lease. Date lease began:
                                Original term in years (including written options):      Remaining term in years (including written options):
       Other. Please explain:
C. Only a partial interest in the property was transferred.  YES          NO        If YES, indicate the percentage transferred:                  %
PART 3. PURCHASE PRICE AND TERMS OF SALE                                     Check and complete as applicable.
A. Total purchase price                                                                                                        $_______________
B. Cash down payment or value of trade or exchange excluding closing costs                                            Amount $_______________
C. First deed of trust @ ______% interest for ______ years.      Monthly payment $_____________                       Amount $_______________
       FHA (___Discount Points)             Cal-Vet    VA (___Discount Points)           Fixed rate      Variable rate
       Bank/Savings & Loan/Credit Union             Loan carried by seller
       Balloon payment $_____________               Due date: _____________
D. Second deed of trust @ ______% interest for ______ years. Monthly payment $_____________                           Amount $_______________
       Fixed rate          Variable rate    Bank/Savings & Loan/Credit Union             Loan carried by seller
       Balloon payment $_____________               Due date: _____________
E. Was an Improvement Bond or other public financing assumed by the buyer?          YES       NO         Outstanding balance $_______________
F. Amount, if any, of real estate commission fees paid by the buyer which are not included in the purchase price              $_______________
G. The property was purchased:      Through real estate broker. Broker name:                             Phone number:        (        )
       Direct from seller       From a family member-Relationship 
       Other. Please explain:
H. Please explain any special terms, seller concessions, broker/agent fees waived, financing, and any other information (e.g., buyer assumed the
   existing loan balance) that would assist the Assessor in the valuation of your property.

PART 4. PROPERTY INFORMATION                                                 Check and complete as applicable.
A. Type of property transferred
       Single-family residence                                                    Co-op/Own-your-own                         Manufactured home
       Multiple-family residence. Number of units:                                Condominium                                Unimproved lot
       Other. Description: (i.e., timber, mineral, water rights, etc.)            Timeshare                                  Commercial/Industrial

B. YES          NO Personal/business property, or incentives, provided by seller to buyer are included in the purchase price. Examples of personal 
                     property are furniture, farm equipment, machinery, etc. Examples of incentives are club memberships, etc. Attach list if available.  
   If YES, enter the value of the personal/business property:                $                           Incentives          $
C. YES          NO A manufactured home is included in the purchase price.
   If YES, enter the value attributed to the manufactured home:                   $
   YES          NO The manufactured home is subject to local property tax. If NO, enter decal number:
D. YES          NO The property produces rental or other income.
   If YES, the income is from:      Lease/rent         Contract           Mineral rights      Other:
E. The condition of the property at the time of sale was:       Good                Average   Fair                   Poor
   Please describe: __________________________________________________________________________________________________
                                                                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/PERSONAL REPRESENTATIVE/CORPORATE OFFICER (PLEASE PRINT) TITLE                                      EMAIL ADDRESS

                           The Assessor’s office may contact you for additional information regarding this transaction.

EF-502-AH-R16-0617-41001186-3
BOE-502-A H(P3) REV. 1 6(0 -17)6
                                                      IMPORTANT NOTICE
The law requires any transferee acquiring an interest in real property or manufactured home subject to local property taxation, and that is assessed by the 
county assessor, to file a change in ownership statement with the county recorder or assessor. The change in ownership statement must be filed at the 
time of recording or, if the transfer is not recorded, within 90 days of the date of the change in ownership, except that where the change in ownership has 
occured by reason of death the statement shall be filed within 150 days after the date of death or, if the estate is probated, shall be filed at the time the 
inventory and appraisal is filed. The failure to file a change in ownership statement within 90 days from the date a written request is mailed by the assessor 
results in a penalty of either: (1) one hundred dollars ($100), or (2) 10 percent of the taxes applicable to the new base year value reflecting the change in 
ownership of the real property or manufactured home, whichever is greater, but not to exceed five thousand dollars ($5,000) if the property is eligible for 
the homeowners' exemption of twenty thousand dollars ($20,000) if the property is not eligible for the homeowners' exemption if that failure to file was not 
willful. The assessor is required to mail the request to file a change in ownership statement to the transferee at the address specified for mailing tax 
information on either the recorded instrument, the document evidencing a transfer of an interest in real property or manufactured home, or on the filed 
preliminary change in ownership report, or, if an address is not specified for mailing tax information, to any address reasonably known to the assessor. 
This penalty will be added to the assessment roll and shall be collected like any other delinquent property taxes, and be subject to the same penalties for 
nonpayment.  
                                                  ADDITIONAL INFORMATION
NAME  AND  MAILING  ADDRESS  OF  BUYER:  Please  make  necessary  corrections  to  the  printed  name  and  mailing  address.  Enter 
Assessor’s Parcel Number, name of seller, buyer’s daytime telephone number, buyer’s email address, and street address or physical 
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.
MAIL PROPERTY TAX INFORMATION TO: Enter the name, address, city, state, and zip code where property tax information should 
be mailed. This must be a valid mailing address.
PRINCIPAL RESIDENCE:  To help you determine your principal residence, consider (1) where you are registered to vote, (2) the home 
address on your automobile registration, and (3) where you normally return after work. If after considering these criteria you are still 
uncertain, choose the place at which you have spent the major portion of your time this year. Check YES if the property is intended as 
your principal residence, and indicate the date of occupancy or intended occupancy.
DISABLED  VETERAN:  If  you  checked  YES,  you  may  qualify  for  a  property  tax  exemption.    A  claim  form  must  be  filed  and  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: If you checked YES to any of these statements, you may qualify for a property tax reassessment exclusion, which may allow 
you to maintain your property’s previous tax base. A claim form must be filed and all requirements met in order to obtain any of 
these exclusions. Contact the Assessor for claim forms.  NOTE: If you give someone money or property during your life, you may be 
subject to federal gift tax.  You make a gift if you give property (including money), the use of property, or the right to receive income from 
property without expecting to receive something of at least equal value in return. The transferor (donor) may be required to file Form 
709, Federal Gift Tax Return, with the Internal Revenue Service if they make gifts in excess of the annual exclusion amount.
G: Check YES if the reason for recording is to correct a name already on title [e.g., Mary Jones, who acquired title as Mary J. Smith, is 
granting to Mary Jones]. This is not for use when a name is being removed from title.
H: Check YES if the change involves a lender, who holds title for security purposes on a loan, and who has no other beneficial interest 
in the property.
      "Beneficial  interest"  is  the  right  to  enjoy  all  the  benefits  of  property  ownership.  Those  benefits  include  the  right  to  use,  sell, 
      mortgage, or lease the property to another. A beneficial interest can be held by the beneficiary of a trust, while legal control of the 
      trust is held by the trustee. 
I: A "cosigner" is a third party to a mortgage/loan who provides a guarantee that a loan will be repaid. The cosigner signs an agreement 
with the lender stating that if the borrower fails to repay the loan, the cosigner will assume legal liability for it.  
M: This is primarily for use when the transfer is into, out of, or between legal entities such as partnerships, corporations, or limited liability 
companies. Check YES only if the interest held in each and every parcel being transferred remains exactly the same.
N:  Check  YES  only  if  this  property  is  subject  to  a  government  or  nonprofit  affordable  housing  program  that  imposes restrictions. 
Property may qualify for a restricted valuation (i.e., may result in lower taxes).
O:  If  you  checked  YES,  you  may  qualify  for  a  new  construction  property  tax  exclusion. 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: The date of recording is rebuttably presumed to be the date of transfer. If you believe the date of transfer was a different date (e.g., 
the transfer was by an unrecorded contract, or a lease identifies a specific start date), put the date you believe is the correct transfer 
date. If it is not the date of recording, the Assessor may ask you for supporting documentation.
B:  Check  the  box  that  corresponds  to  the  type  of  transfer.  If  OTHER  is  checked,  please  provide  a  detailed  description.   Attach  a 
separate sheet if necessary.
C. If  this  transfer  was  the  result  of  an  inheritance  following  the  death  of  the  property  owner,  please  complete  a Change
in Ownership Statement, Death of Real Property Owner, form BOE-502-D, if not already filed with the Assessor’s office.

EF-502-AH-R16-0617-41001186-4
BOE-502-AH (P4) REV. 16 (06-17)

PART 3: PURCHASE PRICE AND TERMS OF SALE
It is important to complete this section completely and accurately.  The reported purchase price and terms of sale are important factors in 
determining the assessed value of the property, which is used to calculate your property tax bill.  Your failure to provide any required or 
requested information may result in an inaccurate assessment of the property and in an overpayment or underpayment of taxes.

A.  Enter the total purchase price, not including closing costs or mortgage insurance.
     “Mortgage insurance” is insurance protecting a lender against loss from a mortgagor’s default, issued by the FHA or a private      
     mortgage insurer.

B.  Enter the amount of the down payment, whether paid in cash or by an exchange.  If through an exchange, exclude the closing costs.
     “Closing costs” are fees and expenses, over and above the price of the property, incurred by the buyer and/or seller, which 
     include title searches, lawyer’s fees, survey charges, and document recording fees.  
C.  Enter the amount of the First Deed of Trust, if any.  Check all the applicable boxes, and complete the information requested.
     A “balloon payment” is the final installment of a loan to be paid in an amount that is disproportionately larger than the regular 
     installment. 

D.  Enter the amount of the Second Deed of Trust, if any.  Check all the applicable boxes, and complete the information requested.
E.  If there was an assumption of an improvement bond or other public financing with a remaining balance, enter the outstanding balance, 
and mark the applicable box. 
     An   “improvement  bond  or  other  public  financing”  is  a  lien  against  real  property  due  to  property-specific  improvement 
     financing, such as green or solar construction financing, assessment district bonds, Mello-Roos (a form of financing that can be 
     used by cities, counties and special districts to finance major improvements and services within the particular district) or general 
     improvement bonds, etc. Amounts for repayment of contractual assessments are included with the annual property tax bill.

F.   Enter the amount of any real estate commission fees paid by the buyer which are not included in the purchase price.

G.  If the property was purchased through a real estate broker, check that box and enter the broker’s name and phone number. If the 
property was purchased directly from the seller (who is not a family member of one of the parties purchasing the property), check the 
“Direct from seller” box. If the property was purchased directly from a member of your family, or a family member of one of the parties who 
is purchasing the property, check the “From a family member” box and indicate the relationship of the family member (e.g., father, aunt, 
cousin, etc.). If the property was purchased by some other means (e.g., over the Internet, at auction, etc.), check the “OTHER” box and 
provide a detailed description (attach a separate sheet if necessary).  
H.  Describe any special terms (e.g., seller retains an unrecorded life estate in a portion of the property, etc.), seller concessions (e.g., 
seller  agrees  to  replace  roof,  seller  agrees  to  certain  interior  finish  work,  etc.),  broker/agent  fees  waived  (e.g.,  fees  waived  by  the 
broker/agent for either the buyer or seller), financing, buyer paid commissions, and any other information that will assist the Assessor in 
determining the value of the property.
PART 4: PROPERTY INFORMATION
A. Indicate the property type or property right transferred. Property rights may include water, timber, mineral rights, etc.
B. Check YES if personal, business property or incentives are included in the purchase price in Part 3.  Examples of personal or business 
property are furniture, farm equipment, machinery, etc. Examples of incentives are club memberships (golf, health, etc.), ski lift tickets, 
homeowners’ dues, etc. Attach a list of items and their purchase price allocation. An adjustment will not be made if a detailed list is not 
provided.
C. Check YES if a manufactured home or homes are included in the purchase price. Indicate the purchase price directly attributable 
to each of the manufactured homes. If the manufactured home is registered through the Department of Motor Vehicles in lieu of being 
subject to property taxes, check NO and enter the decal number.
D. Check YES if the property was purchased or acquired with the intent to rent or lease it out to generate income, and indicate the source 
of that anticipated income. Check NO if the property will not generate income, or was purchased with the intent of being owner-occupied. 
E.Provide your opinion of the condition of the property at the time of purchase. If the property is in “fair ”or “poor” condition, include a 
brief description of repair needed.