Form Boe-267-H - Welfare Exemption Supplemental Affidavit Form, Housing - Elderly Or Handicapped Families Eligibility Based On Family Household Income Page 2

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BOE-267-H (S1B) REV. 6 (8-06)
A. ELIGIBILITY BASED ON FAMILY HOUSEHOLD INCOME
Section 214(f) of the California Revenue and Taxation Code provides that property owned by nonprofit organizations providing
housing for low- and moderate-income elderly or handicapped families can qualify for the welfare exemption from property taxes
only to the extent that household incomes of families residing there do not exceed amounts listed below:
NO. OF PERSONS
NO. OF PERSONS
NO. OF PERSONS
MAXIMUM INCOME
MAXIMUM INCOME
MAXIMUM INCOME
IN FAMILY
IN FAMILY
IN FAMILY
1
4
7
2
5
8
3
6
Note: If a dollar amount is not entered for each number of persons, contact the Assessor for the figures. The amounts are
different for each county and they change annually.
In order to qualify all or a portion of the total property for the exemption, you must have: (1) a signed statement for each family that
qualifies (you keep the statement in case of further audit) and (2) you must complete the report below:
B. LIST OF QUALIFIED FAMILIES
Complete or attach list showing desired information for only those households that qualify; use additional sheets if necessary.
NO. OF PERSONS IN FAMILY
ADDRESS / UNIT NUMBER
MAXIMUM INCOME FOR FAMILY
DOES NOT EXCEED
(use two lines if there are two families in a unit)
(may be more than one family in unit)
$
1.
$
2.
3.
$
$
4.
$
5.
C. RECAP FOR ALL FAMILIES, ELIGIBLE AND INELIGIBLE
EXAMPLE
ACTUAL
1. Number of qualified families (one for each line filled in above).
110
2. Number of nonqualified families. [Occupant(s) did not sign statement,
refused to report, amount of income is over the limit, or unit was occupied
10
by other than an elderly or handicapped family].
3. Total number of families.
120
D. EXEMPTION CALCULATION
EXAMPLE
ACTUAL
Percentage which the number of low and moderate-income elderly and handicapped
families occupying the property is of the total number of families occupying the property.
110/120
/
Maximum percentage of value of property eligible for exemption.
91.66%

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