BOE-265 (P1) REV. 10 (05-13)
cemeTeRY eXempTion clAim
This claim is filed for fiscal year 20____ - 20____
NAME AND MAILING ADDRESS
(Make necessary corrections to the printed name and mailing address)
To receive the full exemption, this claim must
be filed with the Assessor by February 15.
NAME AND ADDRESS OF OWNER OF LAND AND BUILDINGS (if different from person making claim)
NAME OF ORGANIZATION/CORPORATE NAME FROM ARTICLES (IF INCORPORATED)
ASSESSOR’S PARCEL NUMBER
ADDRESS OF PROPERTY (CITY, COUNTY, ZIP CODE)
Yes
No
Is the owner organized (or operating) for profit?
Yes
No
Is the owner incorporated as a non-profit corporation?
If yes, enter the dates of incorporation and amendments: _______________________________________________________
________________________________________
use oF pRopeRTY
Check all that apply.
The property is used or held exclusively for the burial or other permanent deposit of the human dead or for the care, maintenance, or
upkeep of such property or such dead.
The property is not used or held for profit.
eXempTion
Check only one box unless claim covers both inactive and active cemeteries.
The exemption is claimed for the following described inactive property which constitutes and is used exclusively as a cemetery, no
portion of which is being leased, rented, or held for sale by the claimant. Enter the Assessor’s parcel number or legal description:
(if this box is checked and the exemption is not claimed for other properties, sections A and b need not be completed)
____________________________________________________________________________________________________________
The exemption is claimed for the cemetery properties described on the attached property information section(s).
Whom should we contact during normal
FoR AssessoR’s use onlY
business hours for additional information?
Received by
NAME
(Assessor’s designee)
of
ADDRESS (street, city, state, zip code)
(county or city)
on
(date)
Number of Section A in claim
DAYTIME PHONE NUMBER
(
)
EMAIL ADDRESS
ceRTiFicATion
I certify (or declare) 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.
NAME OF PERSON MAKING CLAIM
SIGNATURE OF PERSON MAKING CLAIM
TITLE
DATE
t
This documenT is subjecT To public inspecTion.