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�`\`�of assFs�o NGE IN OWNERSHIP STATEME <br />9 COUNTY OF ALAMEDA <br />Office of Assessor <br />OF p`P��o ROOM 145 1221 OAK STREET <br />OAKLAND, CALIFORNIA 94612 <br />DON J. HUTCHINSON, ASSESSOR Telephone: (415) 874-6036 <br />MARSHALL S. ZAIDEL, CHIEF DEPUTY <br />Transferee's mailing address: (Please Print) <br />gU - 03 F90 6 <br />�90MML NTUL <br />Recording Information: <br />n�,o 4 March 1980 <br />Jannson Raymond T. and Eleanor Document No. 80-038906 <br />(Last name) (First name(s)) <br />1065 Kramer Street San Leandro California 94579 <br />(Street address) (City) (State) (Zip) <br />80 G-1112-82 <br />Assessor's Parcel Number <br />1065 Kramer Street San Leandro California 94579 <br />Property Address City State Zip <br />"IMPORTANT NOTICE" <br />This notice is a written request from the assessor for a change in ownership statement as required by Section 480(a) of the California Revenueand <br />Taxation Code. This statement will remain confidential as required by Section 481 of the Revenue and Taxation Code. <br />"THE LAW REQUIRES ANY PERSON ACQUIRING AN INTEREST IN REAL PROPERTY TO FILE A CHANGE IN <br />OWNERSHIP STATEMENT WITH THE COUNTY RECORDER OR ASSESSOR. THE CHANGE IN OWNERSHIP <br />STATEMENT MUST BE FILED WITHIN 45 DAYS OF THE DATE OF RECORDING OR, IF THE TRANSFER IS NOT <br />RECORDED, WITHIN 45 DAYS OF THE DATE OF THE CHANGE IN OWNERSHIP. THE FAILURE TO FILE A <br />CHANGE IN OWNERSHIP STATEMENT WITHIN 45 DAYS AFTER RECEIPT OF A WRITTEN REQUEST BY THE <br />ASSESSOR RESULTS IN A PENALTY OF ONE HUNDRED DOLLARS ($100) OR 10 PERCENT OF THE CURRENT <br />YEAR'S TAXES ON THE REAL PROPERTY, WHICHEVER IS GREATER. THIS PENALTY WILL BE ADDED TO THE <br />ROLL AND SHALL BE TREATED AND COLLECTED LIKE, AND SHALL BE SUBJECT TO THE SAME PENALTIES <br />FOR DELINQUENCY AS, ALL OTHER TAXES ON THE ROLL ON WHICH IT IS ENTERED." <br />Revenue and Taxation Code Section 480. <br />Please answer the following questions concerning the recorded document and real property described above. <br />PART A: Recorded Document Requiring Partial Completion of Change of Ownership Statement. <br />1. Was this transfer solely between husband and wife? <br />2. Was there a change of name(s) by person(s) holding title? <br />3. Was this document recorded to create, terminate, or reconvey a lender's interest in the property? <br />4. Was this document recorded to substitute a trustee under a deed of trust, mortqaqe, or other similar <br />document? <br />5. Was this document recorded to clarify the present ownership of this property? <br />6. Did this transfer result in the creation of a joint tenancy in which an original owner (transferor) <br />remains as one of the joint tenants? <br />7. Did this transfer result in the termination of a joint tenancy in which the property was returned <br />to the original owner? <br />8a. Is this a transfer of property to a revocable trust? <br />8b. Is this a transfer of property to a trust for the benefit of the seller? <br />8c. Is this a tranfer of property to a trust from which the property reverts to the seller within 12 years? <br />YES NO <br />❑ 12 <br />❑ ❑ <br />❑ rz <br />❑ 0 <br />❑ 12 <br />❑ :M <br />❑ 1\0 <br />❑ 13 <br />❑ ER <br />❑ ❑ <br />IF YOU HAVE ANSWERED "NO" TO ALL OF THE ABOVE QUESTIONS, PLEASE COMPLETE PARTS B AND C ON THE REVERSE SIDE. <br />IF YOU HAVE ANSWERED "YES" TO ANY OF THE ABOVE QUESTIONS, PLEASE SIGN AND DATE THIS FORM HERE. <br />Assessor's Office may contact you for additional information regarding this transaction. <br />I DECLARE UNDER PENALTY OF PERJURY THAT, TO THE BEST OF MY KNOWLEDGE <br />AND BELIEF, THE FOREGOING IS TRUE AND CORRECT. <br />Signed at California, on 19 — <br />MONTH DAY <br />SIGNATURE OF OWNER OR CORPORATE OFFICER TITLE <br />SBE-ASD-AH502 Front <br />111-15-511-12(9-79) <br />