Boe 58 Ah Form – Fill Out and Use This PDF

A. PROPERTY

ASSESSOR’S PARCEL NUMBER

PROPERTY ADDRESS		CITY
RECORDER’S DOCUMENT NUMBER		DATE OF PURCHASE OR TRANSFER
PROBATE NUMBER (if applicable)	DATE OF DEATH (if applicable)	DATE OF DECREE OF DISTRIBUTION (if applicable)

The disclosure of social security numbers is mandatory as required by Revenue and Taxation Code section 63.1. [See Title 42 United

States Code, section 405(c)(2)(C)(i) which authorizes the use of social security numbers for identiication purposes in the administration of any tax.] A foreign national who cannot obtain a social security number may provide a tax identiication number issued by the Internal Revenue

Service. The numbers are used by the Assessor and the state to monitor the exclusion limit.

B.TRANSFEROR(S)/SELLER(S) (additional transferors please complete “C” on the reverse)

1.Print full name(s) of transferor(s)

2.Social security number(s)

3.Family relationship(s) to transferee(s) If adopted, age at time of adoption

4.	Was this property the transferor’s principal residence?		Yes	No
	If yes, please check which of the following exemptions was granted or was eligible to be granted on this property:
	Homeowners’ Exemption	Disabled Veterans’ Exemption
5.	Have there been other transfers that qualiied for this exclusion?			Yes	No

If yes, please attach a list of all previous transfers that qualiied for this exclusion. (This list should include for each property: the County,

Assessor’s parcel number, address, date of transfer, names of all the transferees/buyers, and family relationship. Transferor’s principal residence must be identiied.)

6.	Was only a partial interest in the property transferred?		Yes	No If yes, percentage transferred		%
7.	Was this property owned in joint tenancy?	Yes	No

8.If the transfer was through the medium of a will and/or trust, you must attach a full and complete copy of the will and/or trust and all amendments.

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 that I am the parent or child (or transferor’s legal representative) of the transferees listed in Section C. I knowingly am granting this exclusion and will not file a claim to transfer the base year value of my principal residence under Revenue and Taxation Code section 69.5.

SIGNATURE OF TRANSFEROR OR LEGAL REPRESENTATIVE	PRINTED NAME	DATE
t
SIGNATURE OF TRANSFEROR OR LEGAL REPRESENTATIVE	PRINTED NAME	DATE
t
MAILING ADDRESS		DAYTIME PHONE NUMBER
		(	)
CITY, STATE, ZIP		EMAIL ADDRESS

(Please complete applicable information on reverse side.)

THIS DOCUMENT IS NOT SUBJECT TO PUBLIC INSPECTION

BOE-58-AH (P2) REV. 18 (06-17)

C.TRANSFEREE(S)/BUYER(S) (additional transferees please complete “C” below)

1.Print full name(s) of transferee(s)

2.Family relationship(s) to transferor(s) If adopted, age at time of adoption

If stepparent/stepchild relationship is involved, was parent still married to or in a registered domestic partnership (registered means

registered with the California Secretary of State) with stepparent on the date of purchase or transfer?			Yes	No
If no, was the marriage or registered domestic partnership terminated by:	Death	Divorce/Termination of partnership

If terminated by death, had the surviving stepparent remarried or entered into a registered domestic partnership as of the date of purchase or transfer? Yes No

If in-law relationship is involved, was the son-in-law or daughter-in-law still married to or in a registered domestic partnership with the

daughter or son on the date of purchase or transfer?	Yes	No
If no, was the marriage or registered domestic partnership terminated by:			Death	Divorce/Termination of partnership

If terminated by death, had the surviving son-in-law or daughter-in-law remarried or entered into a registered domestic partnership as of

the date of purchase or transfer?

Yes

No

3.ALLOCATION OF EXCLUSION (If the full cash value of the real property transferred exceeds the one million dollar value exclusion, the transferee must specify on an attachment to this claim the amount and allocation of the exclusion that is being sought.)

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 that I am the parent or child (or transferee’s legal representative) of the transferors listed in Section B; and that all of the transferees are eligible transferees within the meaning of section 63.1 of the Revenue and Taxation Code.

SIGNATURE OF TRANSFEREE OR LEGAL REPRESENTATIVE	PRINTED NAME	DATE
t
MAILING ADDRESS		DAYTIME PHONE NUMBER
		(	)
CITY, STATE, ZIP		EMAIL ADDRESS

Note: The Assessor may contact you for additional information.

B. ADDITIONAL TRANSFEROR(S)/SELLER(S) (continued)

C. ADDITIONAL TRANSFEREE(S)/BUYER(S) (continued)