Form Boe-502-A (P1) - Preliminary Change Of Ownership Report - Placerville, Ca - 2013 Page 2

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EF-502A-R01-1013-0
BOE-502-A (P2) REV. 12 (05-13)
PART 2. OTHER TRANSFER INFORMATION
Check and complete as applicable.
A. Date of transfer, if other than recording date:
B. Type of transfer:
Purchase
Foreclosure
Trade or exchange
Merger, stock, or partnership acquisition (Form BOE-100-B)
Gift
Contract of sale. Date of contract:
Inheritance. Date of death:
Sale/leaseback
Creation of a lease
Termination of a lease. Date lease began:
Assignment of a lease
Original term in years (including written options):
Remaining term in years (including written options):
Other. Please explain:
%
C. Only a partial interest in the property was transferred.
NO
If YES, indicate the percentage transferred:
YES
Check and complete as applicable.
PART 3. PURCHASE PRICE AND TERMS OF SALE
A. Total purchase price
$_______________
B. Cash down payment or value of trade or exchange excluding closing costs
Amount $_______________
C. First deed of trust @ ______% interest for ______ years. Monthly payment $_____________
Amount $_______________
FHA (___
Cal-Vet
VA (___
Discount Points
Discount Points
Fixed rate
)
)
Variable rate
Bank/Savings & Loan/Credit Union
Loan carried by seller
Balloon payment $_____________
Due date: _____________
D. Second deed of trust @ ______% interest for ______ years. Monthly payment $_____________
Amount $_______________
Bank/Savings & Loan/Credit Union
Loan carried by seller
Fixed rate
Variable rate
Due date: _____________
Balloon payment $_____________
E. Was an Improvement Bond or other public financing assumed by the buyer?
NO
Outstanding balance $_______________
YES
F. Amount, if any, of real estate commission fees paid by the buyer which are not included in the purchase price
$_______________
(
)
G. The property was purchased:
Through real estate broker. Broker name:
Phone number:
Direct from seller
From a family member-Relationship
Other. Please explain:
H. Please explain any special terms, seller concessions, broker/agent fees waived, financing, and any other information (e.g., buyer assumed the
existing loan balance) that would assist the Assessor in the valuation of your property.
Check and complete as applicable.
PART 4. PROPERTY INFORMATION
A. Type of property transferred
Co-op/Own-your-own
Manufactured home
Single-family residence
Multiple-family residence. Number of units:
Condominium
Unimproved lot
Other. Description: (i.e., timber, mineral, water rights, etc.)
Commercial/Industrial
Timeshare
Personal/business property, or incentives, provided by seller to buyer are included in the purchase price. Examples of personal
NO
B.
YES
property are furniture, farm equipment, machinery, etc. Examples of incentives are club memberships, etc. Attach list if available.
If YES, enter the value of the personal/business property:
$
Incentives $
C.
NO
A manufactured home is included in the purchase price.
YES
$
If YES, enter the value attributed to the manufactured home:
NO
The manufactured home is subject to local property tax. If NO, enter decal number:
YES
NO
The property produces rental or other income.
D.
YES
If YES, the income is from:
Lease/rent
Contract
Other:
Mineral rights
The condition of the property at the time of sale was:
E.
Good
Average
Fair
Poor
Please describe: __________________________________________________________________________________________________
CERTIFICATION
I certify (or declare) that the foregoing and all information hereon, including any accompanying statements or documents, is true and correct to
the best of my knowledge and belief.
SIGNATURE OF BUYER/TRANSFEREE OR CORPORATE OFFICER
TELEPHONE
DATE
(
)
NAME OF BUYER/TRANSFEREE/LEGAL REPRESENTATIVE/CORPORATE OFFICER (PLEASE PRINT)
TITLE
EMAIL ADDRESS
The Assessor’s office may contact you for additional information regarding this transaction.

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