Affidavit For Exemption Of Personal Property For An Insurance Company Or Financial Corporation Form Page 2
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1
2INSTRUCTIONS
A. GENERAL INSTRUCTIONS
The purpose of this affidavit is to inform the Assessor that the assessee is:
an "Insurance Company" within the meaning of Section 28 of Article XIII of
the California Constitution.
If the firm is not subject to the franchise tax rate specified in Section 28 of
Article XIII of the California Constitution, then the firm is not an "Insurance
Company", and you should not complete this form.
a “Financial Corporation" within the meaning of the Revenue and Taxation
Code. The franchise tax imposed on general corporations in California is
specified in Section 23151 of the Code, and Section 23186 of the Code
specifies the franchise tax rate for banks and financial corporations.
If the firm is not subject to the franchise tax rate specified in Section 23186,
of the Revenue and Taxation Code, the firm is not a “Financial
Corporation”, and you should not complete this form.
If the firm is subject to the Franchise tax rate specified in Section 23186,
complete this form and submit it to the Assessor.
B. AFFIDAVIT INSTRUCTIONS
CORRECT THE NAME AND MAILING ADDRESS IF NECESSARY
1. Type or print the name of the person who is signing the affidavit. The
affidavit must be signed by an authorized person, as defined by BOE-571-L
(S3B) instructions for “Declaration by Assessee”, enclosed.
2. Type or print the title of the person who is signing the affidavit.
3. Type or print the full name of the company that qualified as an insurance
company or financial corporation.
4. Type or print the number issued by the California Department of Insurance
or the number issued by the California Secretary of State. If this number
has not been issued, type or print the equivalent number issued by the
Franchise Tax Board.
5. If other information is attached, check the "Yes" box. For example, if the
insurance company owns personal property in this county under another
name, you should attach a statement with relevant details.
6. Type or print the name, address, and telephone number (including area
code) of the person to contact during normal business hours for additional
information.
This statement is not a public document.
The information declared will be held secret by the Assessor.
This statement is subject to audit.
FCA 3027 (Revised 12/2007)
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