BOE-267, Claim for Welfare Exemption (First Filing)
BOE-267-A, Claim for Welfare Exemption (Annual Filing)
Section 1. Identification of Applicant
(Provide copy of certificate with this claim if first filing).
If you do not have an OCC, have you filed a claim for an OCC with the BOE?
YesNo
If No, see instructions for information on obtaining an OCC claim form.
Section 2. Identification of Property
Section 3. Rehabilitation
Provide a copy of the organization’s formal rehabilitation program, or describe the rehabilitation program and activities in detail on a separate
attachment.
A. Thrift shop, workshop, manufacturing, or similar activities.
Total number of persons employed on the premises on January 1.
Part-time:
Part-time:
B. Total number employed off the premises, but in the operations of the facility as of January 1.
Part-time:
Part-time:
C. Total number of hours worked during the time period included in the financial statements that accompany the claim.
1. Persons being rehabilitated.
2. Staff and/or others.
Number of persons involved:
Whom should we contact during normal business hours for additional information?
D. Salaries and wages paid during the time period included in the financial statements that accompany the claim.
1. Persons being rehabilitated.
Number of persons involved:
2. Staff and/or others.
Number of persons involved:
E. Does a person, management firm, or entity other than the organization filing this claim operate the facility?
YesNo
Attach a copy of the contract or other document that indicates the basis for the salary or fee.
F. Is housing for persons being rehabilitated and/or living quarters for staff provided?
YesNo
If YES, explain the necessity and complete section 4, Housing - Living Quarters.
Section 4. Housing — Living Quarters
A. Total number of persons who were housed on the premises the last night in December. Include persons who may be temporarily away.
1. Total number of persons being rehabilitated
2. Number of unoccupied beds available for persons to be rehabilitated
3. Number of staff members necessary to care for those persons being rehabilitated.Attach a list describing the jobs performed and the number of persons involved.
4. Number of other staff members
5. Number of other persons who are not directly connected with the rehabilitation program
B. Length of stay of persons being rehabilitated who were housed on the premises the last night in December.
1. Number of persons
less than 6 months
6 months - 1 year
1 year - 2 years
2 years or longer (list by number of years)
2. Total. This figure must agree with the total given above for persons being rehabilitated.
C. Do persons being rehabilitated pay, donate, or perform fund producing work for their room and board?
YesNo
D. Do staff members who care for those being rehabilitated pay, donate, or perform work for their room and/or board in lieu of, or from, their salary?
YesNo
E. Do other staff members pay, donate, or perform work for their room and/or board in lieu of, or from, their salary?
YesNo
F. Do the other persons not directly connected with the rehabilitation program pay, donate, or perform work for their room and/or board?
YesNo
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.
Instruction
INSTRUCTIONS FOR FILING CLAIM FOR PROPERTY TAX EXEMPTION UNDER THE CEMETERY EXEMPTION PROVISIONS
