Form Boe-260 - Certificate And Affidavit For Exemption Of Work Of Art

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BOE-260 (P1) REV. 09 (06-11) EXM-236 (REV. 8-11)

COUNTY OF LOS ANGELES • OFFICE OF THE ASSESSOR

500 WEST TEMPLE STREET, ROOM 227

CERTIFICATE AND AFFIDAVIT

LOS ANGELES, CA 90012-2770 • Telephone 213.974.3481

FOR EXEMPTION OF WORK OF ART

Email: exempt@assessor.lacounty.gov

JOHN R. NOGUEZ

Website: assessor.lacounty.gov

Declaration of costs and other related property

ASSESSOR

information as of 12:01 a.m.,

Si desea ayuda en Español, llame al número 213.974.3211

January 1, 20____.

This claim must be filed by 5:00 p.m., February 15.

AFFIDAVIT FOR EXEMPTION OF WORK OF ART

Under the provisions of section 217, Revenue and Taxation

Code, certain articles of personal property which have been

made available for display in a publicly owned art gallery or

museum, or in a museum regularly open to the public and

operated by a nonprofit organization qualified for exemption

under section 23701d of the Revenue and Taxation Code

for a minimum period of 90 days during the 12-month period

immediately preceding January 1, or for less than 90 days

immediately preceding January 1 but which will be made

available for 90 days during the 12-month period commencing

with the first day the property was made available, shall be

exempt from taxation.

NAME OF CLAIMANT

ADDRESS OF CLAIMANT

DAYTIME TELEPHONE NUMBER

(

)

LOCATION OF THE PERSONAL PROPERTY AS OF 12:01 A.M., JANUARY 1

NAME OF ART GALLERY OR MUSEUM IN WHICH THE PROPERTY WAS MADE AVAILABLE FOR DISPLAY

DIRECTOR’S OR OFFICER’S NAME

ADDRESS (Street, City, County, State, ZIP code)

NATURE OF THE PERSONAL PROPERTY FOR WHICH EXEMPTION IS CLAIMED [check the appropriate box(es); additional works of art may be listed on a separate sheet, with nature and description]

ORIGINAL PAINTING

ORIGINAL SCULPTURE

WORK OF THE FREE FINE ARTS (check below)

LITHOGRAPH

ORIGINAL MOSAIC

ORIGINAL STATUARY

ETCHING

PRINTS MADE BY HAND TRANSFER PROCESS

ORIGINAL DRAWING OR SKETCHES

ENGRAVING

WOODCUT

OTHER ORIGINAL WORK OF THE FREE FINE ARTS

DESCRIBE THE PROPERTY AND THE PROCESS BY WHICH IT WAS CREATED IN SUFFICIENT DETAIL TO IDENTIFY

DO THE ITEMS DESCRIBED ABOVE INCLUDE ARTICLES OF UTILITY OR ARTICLES DESIGNED

DOES CLAIMANT HOLD WORKS OF ART PRIMARILY FOR PURPOSES OF SALE?

FOR INDUSTRIAL USE?

YES

CERTIFICATION OF CLAIMANT

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

TITLE

DATE

E-MAIL ADDRESS

CERTIFICATION OF MUSEUM DIRECTOR OR OFFICER

The work of art described above was made available for display from _________________, 20______ to _________________, 20______.

(If additional works are listed on an attachment, the director or officer must sign this certificate and each attachment.)

I certify (or declare) that the information contained herein is true, correct, and complete to the best of my knowledge and belief.

SIGNATURE OF DIRECTOR OR OFFICER

TITLE

DATE