Form Boe-100-B - Statement Of Change In Control And Ownership Of Legal Entities

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COUNTY-ASSESSED PROPERTIES DIVISION
BOE-100-B (S1) REV. 18 (6-08)
STATE OF CALIFORNIA
PO BOX 942879, SACRAMENTO, CA 94279-0064
BOARD OF EQUALIZATION
STATEMENT OF CHANGE IN CONTROL AND OWNERSHIP OF LEGAL ENTITIES
A PENALTY MAY APPLY IF THIS STATEMENT IS NOT FILED ON OR BEFORE THE DUE DATE OF:
STATE USE ONLY
ADDRESSED LEGAL ENTITY:
CIC/CIO Date:
County
Parcels
Identification No.:
(Corporate ID No. for corporations - see instructions for other entity types.)
IMPORTANT: THIS FORM MUST BE COMPLETED AND FILED WITH THE BOARD OF EQUALIZATION.
PLEASE READ THE INSTRUCTIONS (BOE-100-B-INST) AND IMPORTANT NOTICE (BOE-100-B, S5) BEFORE COMPLETING THIS FORM.
YES
NO
1. Since January 1,
, has the addressed legal entity or any of the legal entities under its control obtained more than
50 percent of the ownership interests of any other legal entity(ies), AND, if so, did the acquired entity(ies) hold any interests
in California real property on the date of acquisition (see instructions)? If YES, complete and attach Schedule A and
answer questions 2 and 3. If NO, answer question 2.
2. Since January 1,
, excluding its original creation, has any one person or legal entity obtained, through one or
more transactions, more than 50 percent of the ownership interests in the addressed legal entity, AND, if so, did the
addressed entity hold any interests in California real property on the date that it was acquired (see instructions)? If YES,
complete and attach Schedule B and answer question 3. If NO, answer question 3.
3. Since March 1, 1975, has any transfer of California real property to the addressed legal entity been excluded from
reassessment pursuant to section 62, subdivision (a)(2) of the Revenue and Taxation Code, AND, if so, have cumulatively
more than 50 percent of the ORIGINAL CO-OWNERS' interests in the addressed entity transferred since the exclusion(s)?
(Report only transactions that have not been reported in a previous filing with the Board. See instructions.) If YES,
complete and attach Schedule C and complete certification at bottom of page. If NO, complete certification at
bottom of page.
Schedule Summary:
YES to question 1; Schedule A attached
Based on one or more "YES" answers to questions above, indicate the
corresponding schedule(s) attached; OR
YES to question 2; Schedule B attached
Based on "NO" answers to all questions above, indicate that no schedule
YES to question 3; Schedule C attached, OR
is attached, and return only this page.
NO to questions 1, 2, and 3; no schedule attached
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.
PRINT/TYPE NAME AND TITLE OF PERSON MAKING AFFIDAVIT
SIGNATURE OF PERSON MAKING AFFIDAVIT
PHONE NUMBER
DATE
This statement shall be signed either by an officer, partner, or an employee or agent who has been designated in writing by
the board of directors, partnership, limited liability company or other entity to sign such statements on its behalf.
THIS STATEMENT IS SUBJECT TO AUDIT AND IS NOT A PUBLIC DOCUMENT.

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