MARK CHURCH
EF-502-P-R03-0516-41000433-1                                                                            Assessor - County Clerk - Recorder
BOE-502-P (P1) REV. 0 3(05-16)
                                                                                                        555 County Center
POSSESSORY INTERESTS                                                                                    Redwood City, CA 94063
                                                                                                        P 650.363.4500    F 650.599.7435
ANNUAL USAGE REPORT                                                                                     email assessor@smcacre.org
                                                                                                        web www.smcacre.org

               NAME AND MAILING ADDRESS
               (Make necessary corrections to the printed name and mailing address)

Revenue and Taxation Code section 480.6 requires every state or local governmental entity that is the fee owner of real property in which one 
or more taxable possessory interests have been created or renewed to provide the assessor of the county in which the property is located 
information identifying the holders of a taxable possessory interest, the property involved, and the terms and conditions of the agreement giving 
rise to the taxable possessory interests. If your agency owns any property with taxable possessory interests, you are required to complete and file this 
form with the Assessor by February 15. Report all taxable possessory interests occurring in the prior year even if they ended in the prior year.
IF THERE ARE NO TAXABLE POSSESSORY INTERESTS ON PROPERTY OWNED BY THIS AGENCY, CHECK HERE                                            , AND SIGN, DATE, 
AND RETURN THE FORM TO THE ADDRESS SHOWN ABOVE.
                                                    PROPERTY USAGE
NAME OF TENANT/LESSEE/PERMITTEE                                                    MAILING ADDRESS

LOCATION/DESCRIPTION OF SUBJECT PROPERTY                                           DATE OF TRANSACTION IN WHICH A TAXABLE POSSESSORY INTEREST WAS ACQUIRED

TYPE OF TRANSACTION (check one)                                                    AMOUNT AND TYPE OF CONSIDERATION (i.e. gross, full service, NNN, other)
   CREATION            RENEWAL  SUBLEASE  ASSIGNMENT
TERM OF POSSESSORY INTEREST (including renewal or extension options)               AGENCY PAID EXPENSES (if any, enter dollar amount)

                       ORIGINAL TERM      REMAINING TERM                           CONSIDERATION PAID FOR MASTER LEASE
   SUBLEASE
                       ORIGINAL TERM      REMAINING TERM                           CONSIDERATION PAID FOR UNDERLYING LEASE
   ASSIGNMENTS

NAME OF TENANT/LESSEE/PERMITTEE                                                    MAILING ADDRESS

LOCATION/DESCRIPTION OF SUBJECT PROPERTY                                           DATE OF TRANSACTION IN WHICH A TAXABLE POSSESSORY INTEREST WAS ACQUIRED

TYPE OF TRANSACTION (check one)                                                    AMOUNT AND TYPE OF CONSIDERATION (i.e. gross, full service, NNN, other)
   CREATION            RENEWAL  SUBLEASE  ASSIGNMENT
TERM OF POSSESSORY INTEREST (including renewal or extension options)               AGENCY PAID EXPENSES (if any, enter dollar amount)

                       ORIGINAL TERM      REMAINING TERM                           CONSIDERATION PAID FOR MASTER LEASE
   SUBLEASE
                       ORIGINAL TERM      REMAINING TERM                           CONSIDERATION PAID FOR UNDERLYING LEASE
   ASSIGNMENTS

NAME OF TENANT/LESSEE/PERMITTEE                                                    MAILING ADDRESS

LOCATION/DESCRIPTION OF SUBJECT PROPERTY                                           DATE OF TRANSACTION IN WHICH A TAXABLE POSSESSORY INTEREST WAS ACQUIRED

TYPE OF TRANSACTION (check one)                                                    AMOUNT AND TYPE OF CONSIDERATION (i.e. gross, full service, NNN, other)
   CREATION            RENEWAL  SUBLEASE  ASSIGNMENT
TERM OF POSSESSORY INTEREST (including renewal or extension options)               AGENCY PAID EXPENSES (if any, enter dollar amount)

                       ORIGINAL TERM      REMAINING TERM                           CONSIDERATION PAID FOR MASTER LEASE
   SUBLEASE
                       ORIGINAL TERM      REMAINING TERM                           CONSIDERATION PAID FOR UNDERLYING LEASE
   ASSIGNMENTS

                                       THIS DOCUMENT IS SUBJECT TO PUBLIC INSPECTION

EF-502-P-R03-0516-41000433-2
BOE-502-P (P2) REV. 03 (05-16)

                                                   PROPERTY USAGE
NAME OF TENANT/LESSEE/PERMITTEE                                      MAILING ADDRESS

LOCATION/DESCRIPTION OF SUBJECT PROPERTY                             DATE OF TRANSACTION IN WHICH A TAXABLE POSSESSORY INTEREST WAS ACQUIRED

TYPE OF TRANSACTION (check one)                                      AMOUNT AND TYPE OF CONSIDERATION (i.e. gross, full service, NNN, other)
 CREATION   RENEWAL             SUBLEASE ASSIGNMENT
TERM OF POSSESSORY INTEREST (including renewal or extension options) AGENCY PAID EXPENSES (if any, enter dollar amount)

                 ORIGINAL TERM           REMAINING TERM              CONSIDERATION PAID FOR MASTER LEASE
 SUBLEASE
                 ORIGINAL TERM           REMAINING TERM              CONSIDERATION PAID FOR UNDERLYING LEASE
 ASSIGNMENTS

NAME OF TENANT/LESSEE/PERMITTEE                                      MAILING ADDRESS

LOCATION/DESCRIPTION OF SUBJECT PROPERTY                             DATE OF TRANSACTION IN WHICH A TAXABLE POSSESSORY INTEREST WAS ACQUIRED

TYPE OF TRANSACTION (check one)                                      AMOUNT AND TYPE OF CONSIDERATION (i.e. gross, full service, NNN, other)
 CREATION   RENEWAL             SUBLEASE ASSIGNMENT
TERM OF POSSESSORY INTEREST (including renewal or extension options) AGENCY PAID EXPENSES (if any, enter dollar amount)

                 ORIGINAL TERM           REMAINING TERM              CONSIDERATION PAID FOR MASTER LEASE
 SUBLEASE
                 ORIGINAL TERM           REMAINING TERM              CONSIDERATION PAID FOR UNDERLYING LEASE
 ASSIGNMENTS

NAME OF TENANT/LESSEE/PERMITTEE                                      MAILING ADDRESS

LOCATION/DESCRIPTION OF SUBJECT PROPERTY                             DATE OF TRANSACTION IN WHICH A TAXABLE POSSESSORY INTEREST WAS ACQUIRED

TYPE OF TRANSACTION (check one)                                      AMOUNT AND TYPE OF CONSIDERATION (i.e. gross, full service, NNN, other)
 CREATION   RENEWAL             SUBLEASE ASSIGNMENT
TERM OF POSSESSORY INTEREST (including renewal or extension options) AGENCY PAID EXPENSES (if any, enter dollar amount)

                 ORIGINAL TERM           REMAINING TERM              CONSIDERATION PAID FOR MASTER LEASE
 SUBLEASE
                 ORIGINAL TERM           REMAINING TERM              CONSIDERATION PAID FOR UNDERLYING LEASE
 ASSIGNMENTS

                                                                     CERTIFICATION

I certify (or declare) that I have examined this report, including accompanying schedules, statements or other attachments, and to the best 
of my knowledge and belief it is true, correct, and complete and covers any property required to be reported by the agency named in the 
statement. If prepared by a duly authorized  person other than an agency official, the certification declaration is based on all the information 
of which the preparer has knowledge.
SIGNATURE OF AGENCY REPRESENTATIVE/PREPARER                                               DATE

NAME OF AGENCY REPRESENTATIVE                                                             TITLE

NAME OF PREPARER                                                                          TITLE

PREPARER’S EMAIL ADDRESS                                                                  DAYTIME TELEPHONE NUMBER
                                                                                          (        )
                                THIS DOCUMENT IS SUBJECT TO PUBLIC INSPECTION