Fillable To receive one time reporting treatment QUALIFIED LESSORS (County of Lake)

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To receive one time reporting treatment QUALIFIED LESSORS (County of Lake)

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BROWSE COUNTY OF LAKE (CA) FORMS

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PROPERTY TYPE PRIMARY USE INCIDENTAL USE
QUALIFIED LESSORS’ EXEMPTION CLAIM
BOE-263-A (P1) REV. 07 (06-17)
PROPERTY USED FOR FREE PUBLIC LIBRARIES AND FREE
MUSEUMS AND USED EXCLUSIVELY FOR PUBLIC SCHOOLS,
COMMUNITY COLLEGES, STATE COLLEGES, STATE UNIVERSITIES,
UNIVERSITY OF CALIFORNIA, AND NONPROFIT COLLEGES
To receive one time reporting treatment
for the exemption, this claim must be led
with the Assessor within 120 days of the
commencement date of the lease.
NAME AND MAILING ADDRESS
(Make necessary corrections to the printed name and mailing address)
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 belief.
CERTIFICATION
t
SIGNATURE OF PERSON MAKING CLAIM
TITLE
DATE
DAYTIME TELEPHONE
NAME OF PERSON MAKING CLAIM
EMAIL ADDRESS
( )
IDENTIFICATION OF APPLICANT
MAILING ADDRESS
CITY, STATE, ZIP CODE
CORPORATE ID (IF ANY)
FISCAL YEAR OF CLAIM
LESSOR’S CORPORATE OR ORGANIZATION NAME
IDENTIFICATION OF PROPERTY
USE OF PROPERTY
CITY, COUNTY, ZIP CODE
The lease confers upon the lessee the exclusive right to possession and use of the property.
As used herein a qualifying institution is one whose property qualies for the free public library, free museum, public school,
community college, state college, state university, University of California, or nonprot college property tax exemption.
The lessee institution has the option at the end of the lease term of acquiring the above property described in the lease for $1
(one dollar) or any other nominal sum.
ADDRESS OF PROPERTY (NUMBER AND STREET)
ASSESSOR’S PARCEL NUMBER
20___ 20___
–
Land
Buildings and Improvements
Personal Property
R
Check and state the primary and incidental qualifying uses of the property.
Yes No
Yes No
Yes No
THIS DOCUMENT IS SUBJECT TO PUBLIC INSPECTION
The exemption claim is made for the following property: (if there are numerous properties, please attach a list that clearly identies the
property and the name and address of the lessee)
Important: A lessee’s afdavit, in which the lessee attests to the above statement(s) is provided. Failure to submit/complete the lessee’s afdavit
will result in denial of one time reporting treatment for the exemption. A
separate afdavit is required of each lessee.
BOE-263-A (P2) REV. 07 (06-17)
PROPERTY TYPE
(REAL OR PERSONAL)
PROPERTY DESCRIPTION
FREE PUBLIC LIBRARY COMMUNITY COLLEGE UNIVERSITY OF CALIFORNIA
FREE MUSEUM STATE COLLEGE NONPROFIT COLLEGE
PUBLIC SCHOOL STATE UNIVERSITY
R
Check the type of qualifying use of the property
t
SIGNATURE OF PERSON MAKING CLAIM
TITLE
DATE
DAYTIME TELEPHONE
NAME OF PERSON MAKING CLAIM
EMAIL ADDRESS
( )
MAILING ADDRESS
CITY, STATE, ZIP CODE
NAME OF LESSOR
MAILING ADDRESS
CITY, STATE, ZIP CODE
COMMENCEMENT DATE OF LEASE
PLEASE ATTACH A COPY OF THE LEASE AGREEMENT
DATE PROPERTY PUT TO EXEMPT USE
NAME OF QUALIFYING LESSEE INSTITUTION
RETURN THIS
AFFIDAVIT TO
LESSOR
AFFIDAVIT FOR EXECUTION BY QUALIFYING INSTITUTIONAL LESSEE
The lessee institution has the option at the end of the lease term of acquiring the above property described in the lease for $1
(one dollar) or any other nominal sum.
Yes No
The following property is leased as of January 1 of this year. If personal property is being leased, indicate the type, make, model, serial number,
etc. Attach a separate listing if necessary.
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 belief.
THIS DOCUMENT IS SUBJECT TO PUBLIC INSPECTION
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To receive one time reporting treatment QUALIFIED LESSORS (County of Lake)

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Completed 6 August 2020

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