Form Boe-100-B (S1) - Statement Of Change In Control And Ownership Of Legal Entities Page 5
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BOE-100-B (S1) REV. 21 (1-12)
STATE OF CALIFORNIA
COUNTY-ASSESSED PROPERTIES DIVISION
BOARD OF EQUALIZATION
PO BOX 942879, SACRAMENTO, CA 94279-0064
STATEMENT OF CHANGE IN CONTROL AND OWNERSHIP OF LEGAL ENTITIES
STATE USE ONLY
CIC/CIO Date:
NAME AND ADDRESS OF LEGAL ENTITY:
Result Code
FLE:
Sch. A
Sch. B
Date Entered:
Legal Entity Identification No.:
Note: For corporations and limited liability companies, list the ID Number assigned by California Secretary of State.
For partnerships, list the Federal Employer Identification Number.
FILING REQUIREMENTS under Revenue and Taxation Code (RTC) see Important Notice (BOE-100-B, S4):
This statement must be completed and filed with the Board of Equalization (BOE) within 90 days of a "change in control" (CIC) or
"change in ownership" (CIO) of a legal entity, if as of that date, that legal entity (or entities under its ownership control) also owned (or
under certain circumstances leased) an interest in California real property. Additionally, this statement must also be filed within 90
days of the BOE's written request, regardless of whether a CIC or CIO occurred.
Please refer to the Instructions (BOE-100-B-INST) for definition of terms.
ALL questions below must be completed.
1a. On or after January 1,
and through the certification date below, has the legal entity filing this form
YES
NO
(or any legal entity(ies) under its ownership control) acquired ownership control (more than 50 percent of the
ownership interests) in any other legal entity, through one or more transactions;
AND
1b. Did the acquired legal entity(ies) (or any legal entity(ies) under its ownership control) hold any "interests in
YES
NO
real property" in California on the date of acquisition?
2a. On or after January 1,
and through the certification date below, has any person or legal entity (or
YES
NO
any legal entity(ies) under its ownership control) acquired ownership control (more than 50 percent of the
ownership interests) in the legal entity filing this form (or any legal entity(ies) under its ownership control),
through one or more transactions; AND
2b. Did the legal entity filing this form (or any legal entity(ies) under its ownership control) hold any "interests in
YES
NO
real property" in California on the date of acquisition?
3a. Since March 1, 1975, has any California real property that was transferred to the filing legal entity been
YES
NO
excluded from reassessment under Revenue and Taxation Code section 62(a)(2); AND
3b. Has cumulatively more than 50 percent of any original co-owners' interests in the legal entity filing this
YES
NO
form transferred since the date the real property was originally excluded from reassessment?
If you answered "yes" to both parts of question 1 or 2 above, RTC 64(c) applies. Complete Schedule A.
If you answered "yes" to both parts of question 3 above, RTC 64(d) applies. Complete Schedule B.
CERTIFICATION
Sign
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.
Here
SIGNATURE
TITLE OF PERSON CERTIFYING INFORMATION
EMAIL ADDRESS
PRINT/TYPE NAME OF PERSON MAKING AFFIDAVIT
TELEPHONE 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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