Form Boe-265 - Cemetery Exemption Claim - 2013 Page 2
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5Cemetery / Property Name _______________________
BOE-265 (P2) REV. 10 (05-13)
secTion A: inFoRmATion conceRninG The pRopeRTY
Claimants must complete separate copies of this section for each property for which exemption is sought. Please read instructions before completing.
1: pRopeRTY descRipTion
NAME OF ORGANIZATION
ADDRESS OF THIS PROPERTY (street, city, state, zip code)
COUNTY
ASSESSOR’S PARCEL NUMBER OR LEGAL DESCRIPTION
Declaration of Dedication. Date recorded _________________
Dedication or zoning not required.
Declaration of Intention. Date recorded ___________________
Reason: __________________________________
Total acres of parcel: _____________
Zoning or Cemetery Use Permit. Date granted _____________
2: oWneR And opeRAToR
claimant is:
List the name of any organization which owns or operates
Owner and Operator
the property other than claimaint: ____________________
______________________________________________
Owner only
______________________________________________
Operator only of the cemetery and claims exemption on the:
______________________________________________
Land
______________________________________________
Buildings and other improvements
______________________________________________
Personal property listed herein
3: leAsed oR RenTed To oTheRs
Yes
No
Is any portion of the property described above rented, leased, or being used or operated by some other person or
organization? If yes, describe that portion and its use, and attach a copy of the lease (rental) agreement: ___________
_______________________________________________________________________________________________
Yes
No
Is any equipment or other property at this location being leased, rented, or consigned from someone else? If yes,
attach a list that includes the name and address of the owner and the quantity and description of the property. Property
so listed is not subject to the exemption and will be assessed by the Assessor if owned by a taxable entity.
4: lAnd use
cemetery and related uses:
Burial sites in use or offered for sale.
Number of acres: _________
Mausoleum and columbarium.
Number of sites: _________
Land used for other building sites
Number of acres: _________
Total acres of parcel: ____________
Developed roads and parking areas.
Number of acres: _________
Note: total must equal the total reported in
Walkways and garden areas.
Number of acres: _________
the property description above.
Land used for all other cemetery uses.
Number of acres: _________
noncemetery uses:
Not developed (unused)
Number of acres: _________
Land used for all other purposes
Number of sites: _________
5: buildinGs And impRoVemenTs
building number or name
principal use
other use or uses
6: peRsonAl pRopeRTY
description
principal use
other use or uses
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