Form 571-R - Apartment House Property Statement - 2012 Page 2

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BOE-571-R (P2)(P3) REV. 14 (02-11) ASSR-524 (REV. 8-11)

SCHEDULES OF DEPRECIABLE PROPERTY — SCHEDULES A and B. Items may be listed separately within the year of acquisition on a separate schedule, or

items may be grouped by year of acquisition and listed on the schedules below. If you purchased the property as a unit, report on Schedule A & B the previous owner’s

original cost by the original year of acquisition of the furniture and equipment that was included in your purchase.

Enter the total installed cost including freight, excise taxes, and sales and use taxes of all furniture, and other equipment located on the premises. Include fully depreciated

items. Do not include licensed vehicles. Depreciation schedules may be attached if they provide the desired information.

SCHEDULE A

FURNITURE AND APPLIANCES

SCHEDULE B

OTHER FURNITURE AND EQUIPMENT

(include items in storage; do not include built-ins)

(office, lobby, laundry, pool, vending, signs, fire extinguishers)

Year of

FOR ASSESSOR’S USE ONLY

Original Installed Cost

Acqui-

(NOT depreciated book value)

Factor

Value

Factor

Value

sition

2011

2010

2009

2008

2007

2006

2005

2004

2003

2002

2001

& prior

TOTAL COST $____________________

Enter on line 9, page 1.

Enter on line 8, page 1.

REMARKS:

INSTRUCTIONS

The Revenue and Taxation Code of the State of California requires that every person, upon request of the Assessor, shall file a written property statement under penalty

of perjury with the Assessor within such time as the Assessor may appoint. Please complete this form according to the numbered instructions provided below as your

statement of furnishings and related equipment owned, possessed or controlled by you as of 12:01 a.m., January 1, this year at the location listed. Property which you

are purchasing under a conditional sales contract must be included. Return the completed statement form to the Assessor on or before the date stated in the

official requirement section. In all instances, you must return the original BOE-571-R.

LINE 3.

PROPERTY TRANSFER

Real Property – For purposes of reporting a change in control, real property includes land, structures, or fixtures owned or held under lease from (1) a private

owner if the remaining term of the lease exceeds 35 years, including written renewal options, (2) a public owner (any arm or agency of local, state, or federal

government) for any term or (3) mineral rights owned or held on lease for any term, whether in production or not.

Controlling Interest – When any person or legal entity obtains more than 50 percent of the voting stock of a corporation, or more than a 50 percent ownership

interest in any other type of legal entity. The interest obtained includes what is acquired directly or indirectly by a parent or affiliated entity.

Forms, Filing Requirements & Penalty Information – Contact the Legal Entity Ownership Program Section at 916-274-3410 or refer to the Board’s website

at to obtain form BOE-100-B, applicable filing requirements, and penalty information.

LINE 4.

Check the appropriate box. If yes is checked, enter the name and address of the owner of the furniture or equipment. Briefly describe the nature of the

business or property. Do not report household furnishings owned by tenants and used in their living quarters, or other personal property owned or controlled

by tenants.

LINE 5.

Check the appropriate box. If yes is checked, enter the name and address of the owner or lessor and the quantity and description of the furniture or equipment.

The lessor of the items will be asked to declare them.

LINE 6.

Enter the number of fully furnished, partly furnished, and unfurnished units in the appropriate column or columns. If the owner of the building (other than a

corporation) occupies a unit as his living quarters, do not include it. Please indicate in the REMARKS area the items contained in a typical PARTLY FURNISHED

apartment of each size. A sleeping room is a room with no kitchen facilities; a studio contains a kitchen and a convertible living room; a 1 bedrm. contains a

bedroom, living room, kitchen, etc. Attach additional sheets if necessary.

LINE 7.

Enter the cost of supplies that are on hand at 12:01 a.m. on January 1 of this year. Include janitorial and pool supplies, whether carried in your asset accounts

or expensed.

LINES 8 and 9.

Enter the total cost from Schedules A and B.

SCHEDULE A.

Complete the schedule as instructed. If a portion of the furniture used in your rental units has been placed in storage, include the cost in the schedule

and enter in the remarks the address where stored. Do not include built-in appliances, installed carpeting, or drapes as furniture; such items are

considered part of the building. Include ranges, refrigerators, dishwashers, etc., if not built-in.

SCHEDULE B.

Complete the schedule as instructed. Include all equipment not reported in Schedule A. If you care to attach a schedule listing types of equipment

separately, you may do so.

DECLARATION BY ASSESSEE

The law requires that this property statement, regardless of where it is executed, shall be declared to be true under penalty of perjury under the laws of the State of

California. The declaration must be signed by the assessee, a duly appointed fiduciary, or a person authorized to sign on behalf of the assessee. In the case of a

corporation, the declaration must be signed by an officer or by an employee or agent who has been designated in writing by the board of directors, by name or by title,

to sign the declaration on behalf of the corporation. In the case of a partnership, the declaration must be signed by a partner or an authorized employee or agent. In

the case of a Limited Liability Company (LLC), the declaration must be signed by an LLC manager, or by a member where there is no manager, or by an employee

or agent designated by the LLC manager or by the members to sign on behalf of the LLC.

When signed by an employee or agent, other than a member of the bar, a certified public accountant, a public accountant, an enrolled agent or a duly appointed fiduciary,

the assessee’s written authorization of the employee or agent to sign the declaration on behalf of the assessee must be filed with the Assessor. The Assessor may at

any time require a person who signs a property statement and who is required to have written authorization to provide proof of authorization.

A property statement that is not signed and executed in accordance with the foregoing instructions is not validly filed. The penalty imposed by section 463 of the Revenue

and Taxation Code for failure to file is applicable to unsigned property statements.

THIS STATEMENT IS NOT A PUBLIC DOCUMENT. THE INFORMATION DECLARED

WILL BE HELD SECRET BY THE ASSESSOR.