93517 58 Ah

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Barry Beck
Mono County Assessor
P.O. Box 456
Bridgeport, CA 93517
760-932-5510

BOE-58-AH (P1) REV. 1 (0-1)

CLAIM FOR REASSESSMENT EXCLUSION FOR
TRANSFER BETWEEN PARENT AND CHILD

NAME AND MAILING ADDRESS
(Make necessary corrections to the printed name and mailing address.)

A. PROPERTY
ASSESSOR’S PARCEL NUMBER
PROPERTY ADDRESS

CITY

RECORDER’S DOCUMENT NUMBER

DATE OF PURCHASE OR TRANSFER

PROBATE NUMBER (if applicable)

DATE OF DEATH (if applicable)

DATE OF DECREE OF DISTRIBUTION (if applicable)

The disclosure of social security numbers is mandatory as required by Revenue and Taxation Code section 63.1. [See Title 42 United
States Code, section 405(c)(2)(C)(i) which authorizes the use of social security numbers for identification purposes in the administration of any
tax.] A foreign national who cannot obtain a social security number may provide a tax identification number issued by the Internal Revenue
Service. The numbers are used by the Assessor and the state to monitor the exclusion limit.
B. TRANSFEROR(S)/SELLER(S) (additional transferors please complete “B” on the reverse)
1. Print full name(s) of transferor(s)
2. Social security number(s)
3. Family relationship(s) to transferee(s)
If adopted, age at time of adoption
Yes

4. Was this property the transferor’s principal residence?

No

If yes, please check which of the following exemptions was granted or was eligible to be granted on this property:
Homeowners’ Exemption

Disabled Veterans’ Exemption

5. Have there been other WUDQVIHUs that qualified for this exclusion? 

Yes

No

If yes, please attach a list of all previous transfers that qualified for this exclusion. (This list should include for each property: the County,
Assessor’s parcel number, address, date of transfer, names of all the transferees/buyers, and family relationship. Transferor’s principal
residence must be identified.)
6. Was only a partial interest in the property transferred?
7. Was this property owned in joint tenancy?

Yes

Yes

No

If yes, percentage transferred

%

No

8. If the transfer was through the medium of a trust, you must attach a copy of the trust.
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 and correct to the best of my knowledge and that I am the parent or child (or transferor’s legal
representative) of the transferees listed in Section C. I knowingly am granting this exclusion and will not file a claim to transfer the base year value
of my principal residence under Revenue and Taxation Code section 69.5.
SIGNATURE OF TRANSFEROR OR LEGAL REPRESENTATIVE

DATE

SIGNATURE OF TRANSFEROR OR LEGAL REPRESENTATIVE

DATE

t

t
MAILING ADDRESS

DAYTIME PHONE NUMBER

CITY, STATE, ZIP

EMAIL ADDRESS

(

)

(Please complete applicable information on reverse side.)
THIS DOCUMENT IS NOT SUBJECT TO PUBLIC INSPECTION

BOE-58-AH (P2) REV. 15 (06-11)

C.

Mono County Assessor
P.O. Box 456
Bridgeport, CA 93517
760-932-5510

TRANSFEREE(S) / BUYER(S) (additional transferees please complete “C” below)
1. Print full name(s) of transferee(s)
2. Family relationship(s) to transferor(s)
If adopted, age at time of adoption

If stepparent/stepchild relationship is involved, was parent still married to or in a registered domestic partnership (registered means
registered with the California Secretary of State) with stepparent on the date of purchase or transfer?
Yes
No
If no, was the marriage or registered domestic partnership terminated by:

Death

Divorce/Termination of partnership

If terminated by death, had the surviving stepparent remarried or entered into a registered domestic partnership as of the date of purchase
Yes
No
or transfer?
If in-law relationship is involved, was the son-in-law or daughter-in-law still married to or in a registered domestic partnership with the
Yes
No
daughter or son on the date of purchase or transfer?
If no, was the marriage or registered domestic partnership terminated by:

Death

Divorce/Termination of partnership

If terminated by death, had the surviving son-in-law or daughter-in-law remarried or entered into a registered domestic partnership as of
Yes
No
the date of purchase or transfer?
3. ALLOCATION OF ExCLUSION (If the full cash value of the real property transferred exceeds the one million dollar value exclusion, the
transferee must specify on an attachment to this claim the amount and allocation of the exclusion that is being sought.)
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 and correct to the best of my knowledge and that I am the parent or child (or transferee’s legal
representative) of the transferors listed in Section B; and that all of the transferees are eligible transferees within the meaning of section 63.1 of
the Revenue and Taxation Code.
SIGNATURE OF TRANSFEREE OR LEGAL REPRESENTATIVE

DATE

SIGNATURE OF TRANSFEREE OR LEGAL REPRESENTATIVE

DATE

MAILING ADDRESS

DAYTIME PHONE NUMBER

CITY, STATE, ZIP

EMAIL ADDRESS

t

t

(

)

Note: The Assessor may contact you for additional information.
B. ADDITIONAL TRANSFEROR(S) / SELLER(S) (continued)
NAME

SOCIAL SECURITY NUMBER

SIGNATURE

RELATIONSHIP

C. ADDITIONAL TRANSFEREE(S) / BUYER(S) (continued)
NAME

RELATIONSHIP

BOE-58-AH (P3) REV. 15 (06-11)

Mono County Assessor

CLAIM FOR REASSESSMENT EXCLUSION FOR TRANSFER BETWEEN PARENT AND CHILD
P.O. Box 456
Revenue and Taxation Code, Section 63.1

Bridgeport, CA 93517
760-932-5510

IMPORTANT: In order to qualify for this exclusion, a claim form must be completed and signed by the transferors and a transferee and filed with the
Assessor. A claim form is timely filed if it is filed within three years after the date of purchase or transfer, or prior to the transfer of the real property
to a third party, whichever is earlier. If a claim form has not been filed by the date specified in the preceding sentence, it will be timely if filed within
six months after the date of mailing of a notice of supplemental or escape assessment for this property. If a claim is not timely filed, the exclusion
will be granted beginning with the calendar year in which you file your claim. Complete all of Sections A, B, and C and answer each question or
your claim may be denied. Proof of eligibility, including a copy of the transfer document, trust, or will, may be required. Please note:
1. This exclusion only applies to transfers that occur on or after November 6, 1986;
2. In order to qualify, the real property must be transferred from parents to their children or children to their parents;
3. If you do not complete and return this form, it may result in this property being reassessed.
4. California law provides, with certain limitations, that a “change in ownership” does not include the purchase or transfer of:
• The principal residence between parents and children, and/or
• The first $1,000,000 of other real property between parents and children.
NOTE: Effective January 1, 2009, Revenue and Taxation Code Section 63.1(j) allows a county board of supervisors to authorize a one-time
processing fee of not more than $175 to recover costs incurred by the county assessor due to the failure of an eligible transferee to file a claim for
the parent-child change in ownership exclusion after two written requests have been sent to an eligible transferee by the county assessor.



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