Boe-267 (S1b)(S2) - Claim For Welfare Exemption (First Filing)

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COUNTY OF LOS ANGELES • OFFICE OF THE ASSESSOR
500 WEST TEMPLE STREET, ROOM 225 • LOS ANGELES, CA 90012-2770
Telephone: 213.974.3481 • Email: exmdiv@co.la.ca.us • Website:
Si desea ayuda en Español, llame al número 213.974.3211
RICK AUERBACH
ASSESSOR
CLAIM FOR WELFARE EXEMPTION (FIRST FILING)
(For new locations and/or in-lieu of preprinted claim form BOE-267-A)
EXEMPTION FROM PROPERTY TAXES UNDER SECTIONS 4(b) AND 5 OF ARTICLE XIII OF THE CONSTITUTION OF THE
STATE OF CALIFORNIA AND SECTIONS 214, 254.5 AND 259.5 OF THE REVENUE AND TAXATION CODE
(See also sections 213.7, 214.01-214.1, 215.2, 221-222.5, 225.5, 231, 236, 254-254.6, 259.5, 261, and 270-272 of the Revenue and Taxation Code)
To receive the full exemption, a claimant must complete and file this form with the Assessor by February 15,
or within 30 days of the date of Notice of Supplemental Assessment, whichever comes first.
(Carefully read and follow the accompanying instructions before preparing claim.)
Please check one:
Organization is filing for exemption for the first time in county.
Organization is already receiving exemption for another property in county, organization is seeking
exemption on added location.
states:
(name of person making claim)
1. That as
(title, such as president, etc.)
2. of the
,
(corporate name from articles if incorporated)
3. the corporate identification number of which, if any, is
,
(if none, enter “none”)
4. the organization has an Organizational Clearance Certificate issued by the State Board of Equalization.
Yes
No
If yes, provide Certificate No.
and attach copy if filing for the first time in the county. If no,
please check applicable box below:
An application for the BOE Organizational Clearance Certificate has been filed, but a certificate has not yet been issued, or
An application for the BOE Organizational Clearance Certificate has not yet been filed. (Contact the Board at 916-445-3524 to
request an application form, BOE-277.)
5. the mailing address of which is
;
(give complete address including zip code)
6. that I make this claim for welfare exemption on behalf of this organization for the 20
-20
fiscal year (carefully follow
instructions for the year to be entered here);
7. that the property is used for the actual operation of the exempt activity;
8. that the property is not used or operated by the owner or by any other person so as to benefit any officer, trustee, director,
shareholder, member, employee, contributor, or bondholder of the owner or operator, or any other person, through the
distribution of profits, payment of excessive charges or compensations, or the more advantageous pursuit of his business
or profession;
9. that the property is not used by the owners or members for fraternal or lodge purposes, or for social club purposes except where
such use is clearly incidental to a primary religious, hospital, scientific, or charitable purpose.
10. Prior filings
Has the organization filed for the welfare exemption in this county in prior years?
Yes
No If yes, state:
(a) Latest year filed
(b) Exact name of organization filed under
NOTE: If the owner and operator of the property are not the same, each must execute a separate claim.
11. Address of this property
(give complete address including zip code)
1 2. Is this a new location this year?
Yes
No When was this property first put to an exempt use?
Date
, 20
.
(month/day)
(year)
1 3. If claiming exemption for real property, what date was the property acquired?
NOTE: If the owner and operator of the property are not the same, each must execute a separate claim.
Whom should we contact during normal business
FOR ASSESSOR’S uSE ONLY
hours for additional information?
Received by
NAME
(Assessor’s designee)
of
on
(county or city)
(date)
DAYTIME PHONE NUMBER
EMAIL ADDRESS
(
)
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, correct and complete to the best of my knowledge and belief.
SIGNATURE OF PERSON MAKING CLAIM
DATE
ThIS EXEMPTION CLAIM IS A PubLIC RECORd ANd IS SubjECT TO PubLIC INSPECTION.
BOE-267 (S1) REV. 8 (08-05) EXM-417 (Rev. 08/05)

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