Orange: BOE-267-S

(Example: a person filing a timely claim in January 2011 would enter "2011-2012.")

• IDENTIFICATION OF APPLICANT
  Corporate or Organization Name of Church

  dba Local Church Name

  Mailing Address

  City, State, Zip Code

  Corporate ID (if any) Website Address (if any)

  
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• IDENTIFICATION OF PROPERTY
  Address of Property (Number and Street)

  City, County, Zip Code Assessor's Parcel Number

  1.   Is this real property owned by the church?

  Yes No

  If No, provide the name and address of the owner

  Note: If the owner is not another church, a Church or Welfare Exemption Claim form must be filed. Contact the Assessor.

  
  

  2.   Please check the following, if applicable:

  (a).  The property is owned by an entity organized and operating exclusively for religious purposes.

  (b).  The entity is a nonprofit organization.

  (c).  No part of the net earnings inures to the benefit of any private individual.

  
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• USE OF PROPERTY
  3.   Are all buildings, equipment, and land claimed used exclusively for religious purposes?

  Yes No

  If No, explain

  
  

  4.   Is there any portion of the property currently under construction?

  Yes No

  (a).   If Yes, is that property intended to be used solely for religious purposes?

  Yes No

  (b).   Date(s) of construction:

  (c).   Please describe new construction activity

  
  

  5.   Has any new construction been completed on this property since January 1, 12:01 a.m. last year?

  Yes No

  
  
  

  (a).  Date the new construction was put to exempt use:

  (b).  Describe the use of this property:

  
  

  6.   Does the real property include property used for parking purposes?

  Yes No

  If  Yes, is all real property owned by or leased to the church, upon which exemption is claimed for parking purposes, necessarily and reasonably required for parking of automobiles of persons attending or engaged in religious worship or religious activity, and which is not at other times used for commercial purposes?

  Yes No

  Note: Commercial purposes does not include the parking of vehicles or bicycles, the revenue of which does not exceed the ordinary and necessary costs of operating and maintaining the property for parking purposes.

  
  

  7.   Is there a sanctuary (church) on or adjacent to this property?

  Yes No

  If  No,  a claim for Welfare Exemption must be filed with the Assessor by February 15 each year for the property or portion of the property.

  
  

  8.   Check, as applicable, the type(s) of schools being operated on this property.

  Preschool Kindergarten Secondary school

  Nursery school Elementary school Both secondary and college

  
  

  9.   Are bingo games being operated on this property?

  Yes No

  If  Yes,  a claim for Welfare Exemption must be filed with the Assessor by February 15 each year for the property or portion of the property.

  
  

  10.   Is any equipment or other property at this location being leased or rented from someone else?

  Yes No

  If  Yes,  list in the remarks section the name and address of the owner, and the type, make, model, and serial number of the property.

  Note: Leased personal property is eligible for the Religious Exemption if the personal property is used exclusively for religious purposes.

  
  

  11.   Is any portion of this property used for living quarters for any person?

  Yes No

  If Yes, describe

  Note: Leased personal property is eligible for the Religious Exemption if the personal property is used exclusively for religious purposes.

  
  

  12.   Is any portion of this property vacant and/or unused?

  Yes No

  If Yes, describe

  
  

  13.   Is any portion of this property being rented to, leased to, used and/or operated by a person or organization other than the claimant?

  Yes No

  If Yes, describe that portion, its use, and provide the name and address of the lessee/operator:

  
  

  14.   Has there been any change in the use of this property since 12:01 a.m., January 1 of last year?

  Yes No

  If Yes, describe

  
  

  15.   Remarks.

  
  
  

  Whom should we contact during normal business hours for additional information?

  Name Title

  Daytime Telephone Email Address

  
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• 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 Person Making Claim Title

  Signature of Person Making Claim

  
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