Form Boe-502-A (P1) - Preliminary Change Of Ownership Report - Stockton, Ca - 2010 Page 2

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BOE-502-A (P2) REV. 11 (07-10)

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

If YES, indicate the percentage transferred:

PART 3. PURCHASE PRICE AND TERMS OF SALE

Check and complete as applicable.

A. Total purchase or acquisition price. Do not include closing costs or mortgage insurance.

Interest rate:

Down payment:

Seller-paid points or closing costs:

Balloon payment:

Loan carried by seller

Assumption of Contractual Assessment* with a remaining balance of:

* An assessment used to finance property-specific improvements that constitutes a lien against the real property.

(

)

. The property was purchased:

Through real estate broker. Broker name:

Phone number:

Direct from seller

From a family member

Other. Please explain:

. Please explain any special terms, seller concessions, 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

Manufactured home

Co-op/Own-your-own

Multiple-family residence. Number of units:

Unimproved lot

Condominium

Other. Description: (i.e., timber, mineral, water rights, etc.)

Timeshare

Commercial/Industrial

YES

Personal/business property, or incentives, are included in the purchase price. Examples are furniture, farm equipment,

machinery, club memberships, etc. Attach list if available.

If YES, enter the value of the personal/business property:

YES

A manufactured home is included in the purchase price.

If YES, enter the value attributed to the manufactured home:

YES

The manufactured home is subject to local property tax. If NO, enter decal number:

YES

The property produces rental or other income.

Lease/rent

Contract

Mineral rights

Other:

If YES, the income is from

The condition of the property at the time of sale was:

Good

Average

Fair

Poor

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. This declaration is binding on each and

every buyer/transferee.

SIGNATURE OF BUYER/TRANSFEREE OR CORPORATE OFFICER

DATE

NAME OF BUYER/TRANSFEREE/LEGAL REPRESENTATIVE/CORPORATE OFFICER (PLEASE PRINT)

TITLE

E-MAIL ADDRESS

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