Form Boe-267-L - Welfare Exemption Supplemental Affidavit, Housing - Lower Income Households Page 2

Download a blank fillable Form Boe-267-L - Welfare Exemption Supplemental Affidavit, Housing - Lower Income Households in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Boe-267-L - Welfare Exemption Supplemental Affidavit, Housing - Lower Income Households with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

BOE-267-L (P2) REV. 13 (01-12)

SECTION 4. HOUSEHOLD INFORMATION

A. Eligibility Based on Family Household Income

Section 214(g) of the California Revenue and Taxation Code provides that property owned by a nonprofit organization or eligible limited liability company

providing housing for lower income households can qualify for the welfare exemption from property taxes to the extent that the income of the households

residing therein do not exceed amounts listed below:

NO. OF PERSONS

MAXIMUM

NO. OF PERSONS

MAXIMUM

NO. OF PERSONS

MAXIMUM

NO. OF PERSONS

MAXIMUM

IN HOUSEHOLD

INCOME

IN HOUSEHOLD

INCOME

IN HOUSEHOLD

INCOME

IN HOUSEHOLD

INCOME

Note: If a dollar amount is not entered for each number of persons, contact the County Assessor for the figures. The amounts are different for each

county and change annually. In order to qualify all or a portion of the property for the exemption, you must have: (1) a signed statement for each

household that qualifies (you should keep the statement for future audits); and (2) you must complete the report below.

B. List of Qualified Households

Attach a list showing desired information for only those households that qualify. Please indicate which vacant units are held for low-income housing tenants.

Provide the following information: address/unit number, number of persons in household, maximum income for household.

C. Recap for All Families, Eligible and Ineligible

Note: The low-income calculation under section 214(g) is the value of low-income households to the total area of

EXAMPLE

ACTUAL

the property.

1. Number of residential units designated for use by or serving lower income households.

2. Total number of residential units.

100

3. Area in square feet of qualified lower income households.

75,000

150,000

4. Total area in square feet of building(s).

D. Exemption Calculation

EXAMPLE

ACTUAL

Percentage of the area of lower income households occupying the property to the total area of the property.

75,000 / 150,000

Percentage of value of property eligible for exemption.

50%

E. Application of Limitation on Exemption to $20,000 of tax [Revenue & Taxation Code section 214(g)(1)(C)]

This limitation on the amount of the exemption applies solely to low-income housing properties owned by nonprofit organizations or eligible limited liability

companies that are not financed by government loans, as specified in section 214(g)(1)(A) or do not receive low-income housing tax credits, as provided

in section 214(g)(1)(B). Claimants with properties qualifying for exemption under 214(g)(1)(C) must list all the counties in which such properties are located;

use additional sheets if necessary.

Corporate ID or LLC number:

LIST ALL LOW-INCOME PROPERTIES SUBJECT TO $20,000 TAX EXEMPTION

AMOUNT OF $20,000

COUNTY

APN

PROPERTY STREET ADDRESS

CITY / ZIP CODE

TAX EXEMPTION TO

BE APPLIED

CERTIFICATION

I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing and all information contained herein, including

any accompanying statements or documents, is true, correct, and complete to the best of my knowledge and belief.

NAME OF CLAIMANT

TITLE

DATE

SIGNATURE OF CLAIMANT