Change Of Ownership Statement Resident Owned Mobile Home Park Form - Santa Cruz
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1CHANGE OF OWNERSHIP STATEMENT
Sean Saldavia, Assessor
RESIDENT OWNED MOBILE HOME PARK
701 Ocean St, Room 130
Santa Cruz, CA 95060
New Owner: ______________________________
Park Name:
________________________________
Address: __________________________________
Space Number:
_____________________________
__________________________________
Transfer Date: _______________________________
Mobile Home Decal #: ______________________________
Membership or
Mobile Home Make & Model: _______________________
Stock Certificate #: ___________________________
Exact name of Certificate Owner(s) prior to transfer: ______________________________________________________
Exact name of Certificate Owner(s) after transfer:
________________________________________________________
Type of transfer:
Purchase
Gift
Inheritance: Date of Death ________________________________
Other: Please explain: ______________________________________________________________________________
PART 1:
TRANSFER INFORMATION
Please answer all questions.
Yes No
A. This transfer is solely between spouses (addition or removal of a spouse, death of a spouse, divorce settlement, etc.).
B. This transfer is solely between domestic partners currently registered with the California Secretary of State (addition or
removal of a partner, death of a partner, termination settlement, etc.).
*C. This is a transfer between:
parent(s) and child(ren)
grandparent(s) and grandchild(ren).
*D. This transaction is to replace a principal residence by a person 55 years of age or older.
Within the same county?
Yes
No
*E. This transaction is to replace a principal residence by a person who is severely disabled as defined by Revenue and Taxation
Code section 69.5. Within the same county?
Yes
No
F. This transaction is only a correction of the name(s) of the person(s) holding title to the property (e.g., a name change upon
marriage). If YES, please explain: ______________________________________________________________________
G. This is a transfer of property:
1. to/from a revocable trust that may be revoked by the transferor and is for the benefit of
the transferor, and/or
the transferor’s spouse
registered domestic partner.
2.
to/from a trust that may be revoked by the creator/grantor/trustor who is also a joint tenant, and which names the
other joint tenant(s) as beneficiaries when the creator/grantor/trustor dies.
3.
to/from an irrevocable trust for the benefit of the
creator/grantor/trustor and/or
grantor’s spouse
grantor’s/trustor’s registered domestic partner.
4.
to/from an irrevocable trust from which the property reverts to the creator/grantor/trustor within 12 years.
If you checked YES to statements C, D, or E, you may qualify for a property tax reassessment exclusion, which may allow you to maintain
your previous tax base. A claim form must be filed and all requirements met in order to obtain any of these exclusions. Contact the Assessor
for claim forms.
PART 2:
SALES INFORMATION
A. Amount paid for stock/share certificate:
$ _______________________________
B. Amount paid for mobile home:
$ _______________________________
C. Total purchase price:
$ _______________________________
Additional information: _________________________________________________________________________
I declare under penalty of perjury under the laws of California that the information above is true and correct.
Signature of Owner
Date
Daytime Telephone Number
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