BOE-58-G (P1) REV. 14 (05-14)
DENNIS DRAEGER
ASSESSOR-RECORDER-COUNTY CLERK
CLAIM FOR REASSESSMENT EXCLUSION FOR
COUNTY OF SAN BERNARDINO
TRANSFER FROM GRANDPARENT TO GRANDCHILD
ASSESSOR'S OFFICE
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
DATE OF PURCHASE OR TRANSFER
RECORDER’S DOCUMENT NUMBER
DATE OF DEATH OF GRANDPARENT (if applicable)
PROBATE NUMBER (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) (GRANDPARENTS)
1. Print full name(s) of transferor(s)
2. Was this property the principal residence of the transferor?
Yes
No
If yes, please check which one of the following exemptions was granted or was eligible to be granted on this property:
Homeowners’ Exemption
Disabled Veterans’ Exemption
3. Was real property other than the principal residence of the transferor transferred?
Yes
No
4. Was only a partial interest in the property transferred?
Yes
No
If yes, percentage transferred _______%.
5. Did you own this property as a joint tenant?
Yes
No
6. If the transfer was through the medium of a trust, you must attach a copy of the trust.
7. Print name(s) of child(ren) of transferor(s)/seller(s) who is(are) the parent(s) of transferee(s) (grandchild):
CERTIFICATION
I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing and any accompanying statements are
true and correct to the best of my knowledge and that I am the grandparent (or their 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
t
SIGNATURE OF TRANSFEROR OR LEGAL REPRESENTATIVE
DATE
t
MAILING ADDRESS
DAYTIME PHONE NUMBER
(
)
CITY, STATE, ZIP
EMAIL ADDRESS
THIS DOCUMENT IS NOT SUBJECT TO PUBLIC INSPECTION