Fillable form is required for each location. The Assessor (County of Lake)

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BROWSE COUNTY OF LAKE (CA) FORMS

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CLAIM FOR WELFARE
EXEMPTION (ANNUAL FILING)
To receive the full exemption, a claimant must complete and le this form with
the Assessor by February 15.
Organization Name and Mailing Address: (Make necessary corrections in ink to the printed
name and address.)
TITLE DATE
Last year your organization received the Welfare Exemption for all or part of the property your organization owns at the location listed above. To continue
receiving the exemption for the property you own at this location, you must complete, sign and return this claim form to the Assessor. A separate claim
form is required for each location. The Assessor may contact you for additional information.
A. If you no longer seek an exemption at this location, check here
, sign and return this form to the Assessor. Date Vacated: ________________
B. If your organization is dissolved and therefore no longer needs an Organizational Clearance Certicate, check here
C. Check, if changed within the last year: Mailing Address Organization Name
D. Does your organization have a valid Organizational Clearance Certicate (OCC) issued by the State Board of Equalization? Yes No
If yes, enter OCC No. and date issued
Property Location:
BOE-267-A (P1) REV. 20 (05-19)
20 ____
Property No.: Class:
YES NO Since January 1, last year:
1. Have any of the activities or use on any portion of the property that received an exemption last year changed? If yes, attach an explanation
of the change in activities or use.
2. Is any portion of this property being used for exempt purposes that was not being used in that manner last year?
3. Is any portion of this property vacant or unused? If yes, since (date) Area (sq.ft.)
4. Is any portion of this property used as a retail outlet or for other fundraising purposes? (Note: Thrift stores which are part of a planned,
formal rehabilitation program may be exempt if BOE-267-R is led with this claim.)
5. Is any portion of the property used for living quarters (other than transitional or emergency shelter, low-income housing or housing for the
elderly or handicapped listed under questions 6 or 7)? If yes, and you claim exemption for this portion, submit documentation including
the occupant's position or role in the organization including a statement indicating that the housing continues to be used for organization's
exempt purpose (see “Housing” on reverse) or, if living quarters associated with a rehabilitation program, submit BOE-267-R.
6. Is this property used as low-income housing? If yes, and the property is owned by a nonprot organization or eligible limited liability
company, submit BOE-267-L. If yes, and the property is owned by a limited partnership, submit BOE-267-L1.
7. Is this property used as housing for the elderly or handicapped? If yes, submit BOE-267-H unless care or services are provided or the
property is nanced by the federal government under, but not limited to, sections 202, 231, 236, or 811 of the Federal Public Laws.
8. Do other persons or organizations use any of this property? If yes, submit BOE-267-O if real property is used; for personal property attach
a list describing what is used, the name of the user, the amount received by claimant (if any) and a copy of the lease agreement if not
previously provided to the Assessor.
9. Did this or any portion of this property generate taxable “unrelated business taxable income,” as dened in section 512 of the Internal
Revenue Code? If yes, see “Unrelated Income” on the reverse.
10. Have the organization's income and/or expenses increased by more than 25 percent since last year? If yes, attach a copy of your most
recent and the prior year's complete nancial statements along with an explanation of increase.
11. Is there any equipment or property at this location that is leased or rented to the claimant? If yes, provide the owner's name and address
and a description of the property. This property may be taxable as it is not owned by the claimant.
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.
SIGNATURE OF CLAIMANT
u
ASSESSOR'S USE ONLY
EMAIL ADDRESS
Approved: ALL PART Denied Reason(s) for Denial:
DAYTIME TELEPHONE
( )
NAME OF PERSON TO CONTACT FOR ADDITIONAL INFORMATION (please print)
THIS DOCUMENT IS SUBJECT TO PUBLIC INSPECTION
E. Have you amended the organization's formative documents (i.e., articles of incorporation, constitution, trust instrument, articles of organization) since
last year?
Yes No
If yes, please mail a copy of the amendment to the State Board of Equalization, County-Assessed Properties Division, P.O.
Box 942879, Sacramento, CA 94279-0064. Please include your OCC number. Note to Assessor’s Oce: If the organization is dissolved or the formative
documents were amended, please forward a copy of this page to the Board of Equalization.
Read the information on the reverse side before completing. All questions must be answered. If the answer to any question is “YES,” explain in an
attachment or complete the referenced form. Contact the Assessor if any forms referenced below are needed to complete this application.
Identify the property that your organization owns at this location:
Real property (land/buildings/improvements) Personal property
Taxable Possessory Interest
This organization owns rents/leases the real property at this location:
BOE-267-A (P2) REV. 20 (05-19)
GENERAL INFORMATION
The Welfare Exemption is available only to property, real or personal, owned by a religious, charitable, hospital, or scientic organization and
used exclusively for religious, charitable, hospital, or scientic purposes. It is also available on a taxable possessory interest in publically
owned real property used for exempt purposes by an organization that qualies for the welfare exemption. A public owner is a local, state or
federal agency.
To be eligible for the full exemption, the claimant must le a claim each year on or before February 15. Only 90 percent of any tax, penalty,
or interest may be canceled or refunded when a claim is led between February 16 and December 31 of the current year. If the application is
led on or after January 1 of the next year, only 85 percent of any tax, penalty, or interest may be canceled or refunded. The tax, penalty, and
interest for a given year may not exceed $250. A separate claim must be completed and led for each property for which exemption is sought.
In accordance with Revenue and Taxation Code section 254.5(b)(2), the assessor may institute an audit or verication of the property’s use to
determine whether both the owner and user of the property meet the requirements of Revenue and Taxation Code section 214.
ORGANIZATIONAL CLEARANCE CERTIFICATE
The Assessor may not approve a property tax exemption claim until the claimant has been issued a valid Organizational Clearance Certicate
(OCC) by the State Board of Equalization. If you are seeking exemption on this property, you must provide the organization's OCC No. and
date issued. A listing of organizations with valid OCCs is available on the Board's website (www.boe.ca.gov) and can be accessed at www.boe.
ca.gov/proptaxes/welfareorgeligible.htm. You may also contact the Board at 1-916-274-3430.
HOUSING
If question 5 is answered yes, describe the portion of the property used for living quarters (since January 1 of the prior year). Submit (1)
documentation, including tenets, canons, or written policy, that indicates the organization requires housing be provided to employees and/or
volunteers, or (2) include statement why such housing is incidental to and reasonably necessary for the exempt purpose of the organization. If
the documentation described in items (1) or (2) has been submitted in a previous year for this location, please submit documentation including
the occupant's position or role in the organization with a statement indicating that the housing continues to be used for organization's exempt
purpose. (This question is not applicable where the exempt activity is providing housing.)
USE OF THE PROPERTY BY OTHER ORGANIZATIONS
If question 8 is answered yes, and your organization’s real property is used by another party submit BOE-267-O. If another party only uses your
personal property, then submit an attachment providing the requested information for such personal property and conrm that no real property is
used by other parties. The lease does not need to be provided if furnished in a prior year.
UNRELATED BUSINESS TAXABLE INCOME
If question 9 is answered yes, you must attach the following to the claim:
• the organization's information and tax returns, including Form 990-T, led with the Internal Revenue Service for its immediately preceding year;
• a statement setting forth the amount of time devoted to the organization's income-producing and to its non income-producing activities and,
where applicable, a description of that portion of the property on which those activities are conducted;
• a statement listing the specic activities and locations which produce unrelated business taxable income; and
• a statement setting forth the amount of income of the organization that is attributable to activities in this state and is exempt from income or
franchise taxation and the amount of total income of the organization that is attributable to activities in this state.
ASSESSOR'S USE ONLY
ASSESSED VALUES
ITEM
TOTAL ASSESSED VALUE OF:
LAND IMP ROVEMENTS PERSONAL PROPERTY FIXTURES TOTAL
ITEM
EXEMPTION ALLOWED
LAND IMP ROVEMENTS PERSONAL PROPERTY FIXTURES TOTAL
If another exemption, such as the church, religious, etc., was allowed this year on a portion of the property described in the claim, indicate the type and
amount of the exemption: $
(type) (amount)
By
(Assessor or designee) (date)
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Completed 6 August 2020

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