Fillable Claim For Reassessment Exclusion printable pdf download

DENNIS DRAEGER

BOE-58-AH (P1) REV. 16 (05-14)

ASSESSOR-RECORDER-COUNTY CLERK

CLAIM FOR REASSESSMENT EXCLUSION FOR

COUNTY OF SAN BERNARDINO

ASSESSOR'S OFFICE

TRANSFER BETWEEN PARENT AND CHILD

172 West Third Street

San Bernardino, CA 92415-0310

(909) 387-8307 - 1-877-885-7654

NAME AND MAILING ADDRESS

(Make necessary corrections to the printed name and mailing address.)

A. PROPERTY

ASSESSOR’S PARCEL NUMBER

PROPERTY ADDRESS

CITY

RECORDER’S DOCUMENT NUMBER

DATE OF PURCHASE OR TRANSFER

PROBATE NUMBER (if applicable)

DATE OF DEATH (if applicable)

DATE OF DECREE OF DISTRIBUTION (if applicable)

The disclosure of social security numbers is mandatory as required by Revenue and Taxation Code section 63.1. [See Title 42 United

States Code, section 405(c)(2)(C)(i) which authorizes the use of social security numbers for identification purposes in the administration of any

tax.] A foreign national who cannot obtain a social security number may provide a tax identification number issued by the Internal Revenue

Service. The numbers are used by the Assessor and the state to monitor the exclusion limit.

B. TRANSFEROR(S)/SELLER(S) (additional transferors please complete “B” on the reverse)

1. Print full name(s) of transferor(s)

2. Social security number(s)

3. Family relationship(s) to transferee(s)

If adopted, age at time of adoption

4. Was this property the transferor’s principal residence?

Yes

If yes, please check which of the following exemptions was granted or was eligible to be granted on this property:

Homeowners’ Exemption

Disabled Veterans’ Exemption

5. Have there been other transfers that qualified for this exclusion?

Yes

If yes, please attach a list of all previous transfers that qualified for this exclusion. (This list should include for each property: the County,

Assessor’s parcel number, address, date of transfer, names of all the transferees/buyers, and family relationship. Transferor’s principal

residence must be identified.)

6. Was only a partial interest in the property transferred?

Yes

No If yes, percentage transferred

7. Was this property owned in joint tenancy?

Yes

8. If the transfer was through the medium of a trust, you must attach a copy of the trust.

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 that I am the parent or child (or transferor’s legal

representative) of the transferees listed in Section C. I knowingly am granting this exclusion and will not file a claim to transfer the base year value

of my principal residence under Revenue and Taxation Code section 69.5.

SIGNATURE OF TRANSFEROR OR LEGAL REPRESENTATIVE

DATE

SIGNATURE OF TRANSFEROR OR LEGAL REPRESENTATIVE

DATE

MAILING ADDRESS

DAYTIME PHONE NUMBER

(

)

CITY, STATE, ZIP

EMAIL ADDRESS

(Please complete applicable information on reverse side.)