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WELFARE EXEMPTION SUPPLEMENTAL AFFIDAVIT, HOUSING LOWER INCOME HOUSEHOLDS (County of Lake)

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BOE-267-L (P1) REV. 20 (05-19)
WELFARE EXEMPTION SUPPLEMENTAL AFFIDAVIT,
HOUSING — LOWER INCOME HOUSEHOLDS
This is a Supplemental Adavit led with
SECTION 1. IDENTIFICATION OF APPLICANT
SECTION 2. IDENTIFICATION OF PROPERTY
SECTION 3. GOVERNMENT FINANCING OR TAX CREDITS; USE RESTRICTION
As to the low-income housing property for which this claim is made, the applicant certies that (check all applicable boxes):
Mailing Address (number and street)
City, State, Zip Code
Name of Organization
Corporate ID or LLC Number
This claim is led for scal year 20 _____ — 20 _____
BOE-267, Claim for Welfare Exemption (First Filing)
BOE-267-A, Claim for Welfare Exemption (Annual Filing)
City, County, Zip Code
Address of property (number and street)
Date Property Acquired
A. There is an enforceable and veriable agreement with a public agency or a recorded deed restriction, or other legal document, that restricts
the project’s usage and that provides that the units designated for use by lower income households are continuously available to or occupied
by lower income households at rents that do not exceed those prescribed by section 50053 of the Health and Safety Code, or, to the extent
that the terms of federal, state, or local nancing or nancial assistance conicts with section 50053, rents that do not exceed those prescribed
by the terms of the nancing or nancial assistance. For property tax exemption purposes, a unit is considered occupied by a lower income
household if the occupants were qualied when their occupancy began, as long as the household income is not above 140% of area median income
("over-income" tenants), the unit is rent restricted, and the property receives federal low-income housing tax credits. See Revenue and Taxation
Code section 214(g)(2)(A)(iii).
(1) The acquisition, construction, rehabilitation, development, or operation of the property is nanced with government nancing in the form
of tax-exempt mortgage revenue bonds; general obligation bonds; local, state, or federal loans or grants; or any loan insured, held, or
guaranteed by the federal government; or project–based federal funding under section 8 of the Housing Act of 1937. (The term “government
nancing” does not include federal rental assistance through tenant rent-subsidy vouchers under section 8 of the Housing Act of 1937.)
(2) The owner is eligible for and receives state low-income housing tax credits pursuant to Revenue and Taxation Code sections 12205, 12206,
17057.5, 17058, 23610.4, and 23610.5 or federal low-income housing tax credits pursuant to section 42 of the Internal Revenue Code.
(3) Ninety (90) percent or more of the occupants of the property are lower income households whose rents do not exceed the rent prescribed by
section 50053 of the Health and Safety Code. The total exemption amount allowed under Revenue and Taxation Code section 214(g)(1)(C)
to a taxpayer, with respect to a single property or multiple properties for any scal year on the sole basis of the application of this subdivision,
may not exceed twenty million dollars ($20,000,000) in assessed value.
If this is the basis for seeking exemption, you must also complete form BOE-267-L2, Welfare Exemption Supplemental Adavit,
Housing - Lower Income Household - Tenant Data. (Please note: unlike other welfare exemption claim forms and supplemental adavit
forms, BOE-267-L2 is condential.)
C. At least one of the following criteria is applicable (check one):
B. The funds which would have been necessary to pay property taxes are used to maintain the aordability of, reduce rents otherwise necessary for,
the units occupied by lower income households.
SECTION 4. HOUSEHOLD INFORMATION
A1. Eligibility Based on Family Household Income - Lower Income Households
Section 214(g) of the California Revenue and Taxation Code provides that property owned by a nonprot organization or eligible limited liability company
providing housing for lower income households can qualify for the welfare exemption from property taxes to the extent that the income of the households
residing therein do not exceed amounts listed below: (See Section 4.A2 for income limit exception)
NO. OF PERSONS
IN HOUSEHOLD
MAXIMUM
INCOME
NO. OF PERSONS
IN HOUSEHOLD
MAXIMUM
INCOME
NO. OF PERSONS
IN HOUSEHOLD
MAXIMUM
INCOME
NO. OF PERSONS
IN HOUSEHOLD
MAXIMUM
INCOME
1 3 5 7
2 4 6 8
If you are ling this supplemental adavit with BOE-267 (First Filing), submit a copy of the regulatory agreement, recorded deed restriction, or
other legal document.
THIS DOCUMENT IS SUBJECT TO PUBLIC INSPECTION
BOE-267-L (P2) REV. 20 (05-19)
A2. Eligibility Based on Family Household Income - 140% of Area Median Income (AMI)
Section 214(g)(2)(A)(iii) of the Revenue and Taxation Code provides that under certain circumstances, property eligible for and receives federal low income
housing tax credits (LIHTC) pursuant to Section 42 of the Internal Revenue Code can qualify for the welfare exemption from property taxes to the extent
that the income of the households residing therein do not exceed amounts listed below:
NO. OF PERSONS
IN HOUSEHOLD
140% AMI
NO. OF PERSONS
IN HOUSEHOLD
140% AMI
NO. OF PERSONS
IN HOUSEHOLD
140% AMI
NO. OF PERSONS
IN HOUSEHOLD
140% AMI
1 3 5 7
2 4 6 8
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 CLAIMANT TITLE DATE
t
COUNTY APN PROPERTY STREET ADDRESS CITY / ZIP CODE
AMOUNT OF
$20,000,000
ASSESSED VALUE
EXEMPTION TO BE
APPLIED
DAYTIME TELEPHONE
EMAIL ADDRESS
(
Does this property include commercial space?
Yes No
Give a brief description of its use:
Note: If a dollar amount is not entered for each number of persons, contact the County Assessor for the gures. The amounts are dierent for each
county and change annually. In order to qualify all or a portion of the property for the exemption, you must have: (1) a signed statement for each
household that qualies (you should keep the statement for future audits) and (2) you must complete parts 4B, 4C, and Section 5 below.
1. Number of residential units designated for use by or serving lower income households - lower income limits.
2. Number of residential units occupied by households exceeding lower income limits but do not exceed 140% AMI
("over-income" tenants), as reported on BOE-267-L3.
3. Total number of qualied households (C1 + C2)
4. Total number of residential units in property.
5. Percentage which the number of "units serving lower income households" is of the total number of residential units.
(C3 / C4 above)
88
2
90
100
90%
(90/100)
If you have units meeting the criteria in A2, that do not meet the criteria of A1 upon which you seek exemption, check here to conrm the property has
federal LIHTC and submit BOE-267-L3, Welfare Exemption Supplemental Adavit, Households Exceeding Low-Income Limits - "Over-Income"
Tenant Data (140% AMI). BOE-267-L3 is condential.
B. List of Qualied Households
Attach a list showing desired information for only those households that qualify. Identify which units qualify under the 140% AMI criteria indicated in
Section 4.A2. Also, please identify the vacant units reserved for low-income households. Provide the following information: address/unit number, number
of persons in household, maximum income for household.
C. Number of Units Serving Lower Income Households
Note: Under section 214(g), the exemption percentage is the total number of "units serving lower income
households" divided by the total number of residential units. This percentage is applied to the entire property
including "related facilities".
SECTION 5. PROPERTY USE
SECTION 6. APPLICATION OF EXEMPTION LIMIT OF $20,000,000 OF ASSESSED VALUE [REVENUE & TAXATION CODE SECTION 214(g)(1)(C)]
This limitation on the amount of the exemption applies solely to low-income housing properties owned by nonprot organizations or eligible limited liability
companies that are not nanced by government loans, as specied in section 214(g)(1)(A) or do not receive low-income housing tax credits, as provided
in section 214(g)(1)(B). Claimants with properties qualifying for exemption under 214(g)(1)(C) must list all the counties in which such properties are located.
Use additional sheets if necessary.
LIST ALL LOW-INCOME PROPERTIES SUBJECT TO $20,000,000 OF ASSESSED VALUE EXEMPTION
SIGNATURE OF CLAIMANT
BOE-267-L (P3) REV. 20 (05-19)
INSTRUCTIONS FOR FILING
WELFARE EXEMPTION SUPPLEMENTAL AFFIDAVIT,
HOUSING — LOWER INCOME HOUSEHOLDS
FILING OF AFFIDAVIT
This adavit is required under the provisions of sections 214(g), 214.15, 251, and 254.5 of the Revenue and Taxation Code
and must be led when seeking exemption on low-income housing property owned and operated by a nonprot corporation or
eligible limited liability company. A separate adavit must be led for each location and the income of the occupants must not
exceed certain limits (see section 4 of this form). This adavit supplements the claim for Welfare Exemption and must be led
with the county assessor by February 15 to avoid a late ling penalty under section 270. If the property for which exemption is
sought is used for low-income rental housing and is owned by a nonprot corporation or eligible limited liability company, you
must complete and le this form; failure to do so will result in denial of the exemption. If the low-income rental housing is owned
by a limited partnership, do not complete this supplemental adavit form; use BOE-267-L1, Welfare Exemption Supplemental
Adavit, Low – Income Housing Property of Limited Partnership. The claimant should provide each household living on the
property with a copy of BOE-267-L-A, Lower Income Households – Family Household Income Reporting Worksheet.
The organization claiming the exemption keeps the completed, signed statements received from households in case
of further audit. Do not submit the worksheets with your ling.
FISCAL YEAR
The scal year for which an exemption is sought must be entered correctly. The proper scal year follows the lien date (12:01
a.m., January 1) as of which the taxable or exempt status of the property is determined. For example, a person ling a timely
claim in February 2018 would enter “2018-2019” on line four of the claim; a “2017-2018” entry on a claim led in February
2018 would signify that a late claim was being led for the preceding scal year.
SECTION 1. Identication of Applicant
Identify the name of the organization seeking exemption on the low-income housing property, corporate identication number
or LLC number, and mailing address.
SECTION 2. Identication of Property
Identify the location of the low-income housing property, county in which the property is located, and the date the property
was acquired by the organization.
SECTION 3. Government Financing or Tax Credits; Use Restriction
Check all applicable boxes to certify if: (1) the property use is restricted to low-income housing by a recorded regulatory
agreement or recorded deed restriction or other legal document, and (2) the funds that would have been necessary to pay
property taxes are used to maintain the aordability of the housing or to reduce the rents for the units occupied by lower
income households, and (3) the property receives government nancing, or state/federal low-income housing tax credits,
or 90 percent or more of the occupants of the property are lower income households whose rent does not exceed the rent
prescribed by section 50053 of the Health and Safety Code. If the property does not have government nancing or low-income
housing tax credits and item C(3) in Section 3 of this supplemental adavit form is checked, then claimant must also submit
BOE-267-L2, Welfare Exemption Supplemental Adavit, Housing – Lower Income Households – Tenant Data.
BOE-267-L (P4) REV. 20 (05-19)
INSTRUCTIONS FOR FILING
WELFARE EXEMPTION SUPPLEMENTAL AFFIDAVIT,
HOUSING — LOWER INCOME HOUSEHOLDS
SECTION 4B. List of Qualied Households
Include a list of all of households that qualify for exemption based on the maximum income level for the county for the
claim year where the property is located (see dollar amounts in Sections 4.A1 and 4.A2). Additionally, claimant must submit
BOE-267-L3 to include a list of households that qualify for exemption under the 140% AMI criteria indicated in Section 4.A2.
Also, please list vacant units held for low-income housing tenants.
SECTION 4C
Revenue and Taxation Code section 214(g)(1) states rental housing and "related facilities" are entitled to a partial exemption
equal to that percentage of the value of the property that is equal to the percentage that the number of units serving lower
income households represents of the total number of residential units. The percentage determined shall apply to the total
value of both improvements and land. Identify the number of units designated for use by or serving lower income households
and the total number of residential units for the property.
Units Serving Lower Income Households
"Units serving lower income households" shall mean units that are occupied by lower income households at an aordable
rent, as dened in section 50053 of the Health and Safety Code or, to the extent that the terms of federal, state, or local
nancing or nancial assistance conicts with section 50053, rents that do not exceed those prescribed by the terms
of the nancing or nancial assistance. Eective October 13, 2017, pursuant to Revenue and Taxation Code section
214(g)(2)(A)(iii), a unit in a property that receives federal low income housing tax credits shall continue to be treated as
occupied by a lower income household if the occupants were lower income households on the lien date in the scal year in
which their occupancy of the unit commenced and the unit continues to be rent restricted, notwithstanding an increase in
the income of the occupants of the unit to 140 percent of area median income (AMI), adjusted for family size ("over-income"
tenants). Units reserved for lower income households at an aordable rent that are temporarily vacant due to tenant turnover
or repairs shall be counted as occupied.
Related Facilities
Revenue and Taxation Code section 214(g)(3)(B) states "related facilities" means any manager's units and any and all
common area spaces that are included within the physical boundaries of the rental housing development, including, but not
limited to, common area space, walkways, balconies, patios, clubhouse space, meeting rooms, laundry facilities, and parking
areas, except any portions of the overall development that are nonexempt commercial space.
SECTION 5
This section requests information on any commercial space. If applicable, briey describe the commercial space (i.e., multi-
story building with residential use on oors 2-5 and retail space on ground oor) and use.
SECTION 6
This section requests identication of all low-income housing properties in California where the sole basis of exemption
claimed is under the provisions of Revenue and Taxation Code section 214(g)(1)(C). If you checked item 3(C) in Section 3
on any supplemental adavit form BOE-267-L led with an assessor in California, you must list such properties.
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WELFARE EXEMPTION SUPPLEMENTAL AFFIDAVIT, HOUSING LOWER INCOME HOUSEHOLDS (County of Lake)

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Completed 6 August 2020

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