Provide a copy of the certificate issued by the State Board of Equalization (Board), and a copy of the
finding sheet issued by the Board.
CHECK IF CHANGED WITHIN THE LAST YEAR
Mailing address
Corporate name
Organization's formative document (amendment to articles of incorporation, constitution, trust instrument, articles of organization)
If you do not have an OCC, have you filed a claim for an OCC with the Board?
YesNo
If No, see instructions for obtaining an OCC.
PRIOR YEAR FILINGS
Has the organization filed for the welfare exemption in this county in prior years?
YesNo
IDENTIFICATION OF PROPERTY
1
2
Is this a New Location this Year?
YesNo
3
When Was the Property Put to Exempt Use?
4
Fiscal Year of Claim (See Instructions)
-
5
Real Property If Claiming an Exemption for Real Property, on What Date Was the Property Acquired
5(a)
Land. If Seeking an Exemption on Land, Provide the Following:
(1)
Area in Acres or Square Feet
(2)
Primary and Incidental Use of the Property Described
5(b)
Building or Improvements. If Seeking an Exemption on Building or Improvements, Provide the Following:
(1)
Building Number or Name, Number of Floors, Type of Construction
(2)
Primary and Incidental Use of the Property Described
5(c)
5(c) Personal Property. Personal Property is Exempt Under Revenue and Taxation Code Section 215. It Is Not Necessary to List Personal Property Owned by the Organization.
6
Owner and Operator. Check as Applicable
Claimant is:
Owner and operatorOwner onlyOperator only
and claims exemption on all
LandBuildings and improvements
If persons or organizations other than the claimant can use this property, please provide on an attached list the name of the user, frequency of use, and square footage used.
Whom should we contact during normal business hours for additional information?
USE OF PROPERTY
7
Leased or Rented Since January 1 of Prior Year.
(a)
YesNo
Is any portion of the property described rented, leased, or being used or operated part time or full time by some other person or organization?
If Yes, describe that portion and its use and attach a copy of the agreement, and list the amount received by claimant.
(b)
YesNo
Is any equipment or other property at this location being leased, rented, or consigned from someone else?
If Yes, list equipment and other property at this location that is being leased, rented, or consigned to the claimant.
Please list the name and address of lessor or consignor and the quantity and description of the property, and attach to the claim.
Property so listed is not subject to the exemption, and will be assessed by the Assessor if owned by a taxable entity.
8
Sale of Personal Property Since January 1 of Prior Year.
YesNo
Is any portion of the property used to operate a store, thrift shop, restaurant, bar, or other facility making sales to members or the general public?
If Yes, (1) list the hours per week the business is operated and; (2) describe the nature of articles sold:
9
Expansion.
YesNo
Do you contemplate any capital investment in the property within the next year?
10
Please Check the Following, If Applicable.
The property is owned by a veterans' organization which has been chartered by the Congress of the United States. The property is used for the actual operation of the charitable activity. The property is not used or operated by the owner or by any other person so as to benefit any officer, trustee, director, shareholder, member, employee, contributor, or bondholder of the owner or operator, or any other person, through the distribution of profits, payment of excessive charges or compensations, or the more advantageous pursuit of the business or profession. The property is not used by the owners or members for fraternal or lodge purposes, or for social club purposes except where such use is clearly incidental to a primary charitable purpose.
11
Financial Statements Relating Exclusively to This Property's Location.
Attach to this claim a copy of your operating statement (income, expenses) and balance sheet (assets, liabilities) for the calendar or fiscal year immediately preceding the claim year.
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, correct and complete to the best of my knowledge and belief.
Instruction
Instructions for Filing Qualified Lessors' Exemption