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11 <br />BOE-502-A (Back) Rev. 5 (8-03) File No. 0131-611961ala (MC) <br />PRELIMINARY CHANGE OF OWNERSHIP REPORT <br />Please answer, to the best of your knowledge, all applicable questions, then sign and date. If a question does not apply, indicate with N/A.' <br />PART III: PURCHASE PRICE & TERMS OF SALE <br />A. CASH DOWN PAYMENT OR Value of Trade or Exchange (excluding closing cost) Amount: v a <br />B. FIRST DEED OF TRUST @ % Interest for years. Payments/Mo=$ (Prin. & Int.) Amount: <br />[ ] FHA [ ] Fixed Rate [ ] New Loan <br />[ ] Conventional [ ] Variable Rate [ ] Assumed Existing Loan Balance <br />[ ] VA [ ] All Inclusive D.T. ($ Wrapped) [ ] Bank or Savings & Loan <br />[ ] Cal -Vet [ ] Loan Carried By Seller [ ] Finance Company <br />Balloon Payment [ ] Yes [ ] No Due Date Amount: <br />C. SECOND DEED OF TRUST % Interest for years. Payments/Mo=$ (Prin. & Int.) Amount: <br />[ ] Bank or Savings & Loan [ ] Fixed Rate [ ] New Loan <br />[ ] Loan Carried by Seller [ ] Variable Rate [ ] Assumed Existing Loan Balance <br />Balloon Payment [ ] Yes [ ] No Due Date Amount: <br />D. OTHER FINANCING — Is other financing involved not covered in (B) and (C) above? [ ] Yes [ ] No Amount: <br />Type % Interest for years. Payments/Mo=$ (Prin. & Int. only) <br />( ] Bank or Savings & Loan [ ] Fixed Rate [ ] New Loan <br />[ ] Loan Carried by Seller [ J Variable Rate [ ] Assumed Existing Loan Balance ,- <br />Balloon Payment [ ] Yes [ ] No Due Date Amount: <br />E. WAS AN IMPROVEMENT BOND ASSUMED BY THE BUYER? [ ] Yes [ ]NO Outstanding Balance: Amount: r <br />F. TOTAL PURCHASE PRICE (or acquisition price, /f traded or exchanged, include real estate commission dpaid) <br />Total Items A through E Z o. Q v <br />G. PROPERTY PURCHASED [ ] Through a broker [A Direct from seller [ ] From a family member [ ] Other (please explainf <br />If purchased through a broker, provide broker's name and phone number: <br />Please explain any special terms, seller concessions, or financing and any other information that would help the Assessor understand the purchase price and <br />terms of sale: <br />PART IV: PROPERTY INFORMATION <br />A. TYPE OF PROPERTY TRANSFERRED: <br />[ ] Single -Family Residence [ ] Agricultural [ ] Timeshare <br />[ ] Multiple -family residence (no. of units: ) ( ] Co-op/Own-your-own [ ] Manufactured home <br />[�C] Commercial/Industrial [ ] Condominium [ ] Unimproved lot <br />[ ] Other (Description: i.e., timber, mineral, water rights, etc. ) <br />IS THIS PROPERTY INTENDED AS YOUR PRINCIPAL RESIDENCE? [ ] Yes [X] No <br />If yes, enter date of occupancy / / or intended occupancy <br />month day year month day year <br />C. IS PERSONAL PROPERTY INCLUDED IN PURCHASE PRICE (i.e., furniture, farm equipment, machinery, etc.) <br />(other than a manufactured home subject to local property tax?) [ ] Yes [A No <br />If yes, enter the value of the personal property included in the purchase price $ (Attach itemized list ofpersona/ property.) <br />D. IS A MANUFACTURED HOME INCLUDED IN PURCHASE PRICE? [ ] Yes [ i=J No <br />If yes, how much of the purchase price is allocated to the manufactured home? $ <br />Is the manufactured home subject to local property tax? [ ] Yes [ ] No What is the decal number? <br />E. DOES THE PROPERTY PRODUCE INCOME? [A] Yes [ ] No If yes, is the income from: <br />[)a ] Lease/Rent [ ] Contract [ ] Mineral Rights [ ] Other (please explain): <br />F. WHAT WAS THE CONDITION OF PROPERTY AT THE TIME OF SALE? <br />[ ] Good [ ] Average [ ] Fair [;a] Poor <br />Please explain physical condition of the property and provide any other information (such as restrictions, etc.) that would assist the Assessor in <br />determining the value of the property: <br />CERTIFICATION <br />OWNERSHIP TYPE <br />(check) <br />Proprietorship <br />[ ] <br />Partnership <br />[ ] <br />I certify that the foregoing is true, correct and complete to the best of my knowledge and belief. <br />Corporation <br />[ ] <br />This declaration is binding on each and every co-owner and/or partner. <br />Other <br />[ ] <br />NAME OF TRANSFEREE OR OFFICER OF TRANSFEREE (typed or printed) <br />TITLE <br />Mc & 0.14 <br />/ in _in IL A - <br />SIGNATURE OF TRANSFERS <br />ER OF TRANSFEREE <br />ATE <br />/ <br />I <br />.9 tiF <br />NAME OF ENTITY (typed or <br />ted) <br />FEDERAL EMPLOYER ID NUMBER <br />/J y0 <br />a.l.t <br />ADDRESS (typed or pnnted) <br />G <br />7 dO <br />LEPHONE NUMBER <br />DATE <br />1 <br />NOTE: The Assessor may contact you for further information <br />If a document evidencing a change of ownership is presented to the recorder for recordation without the concurrent Filing of a preliminary <br />change of ownership report, the recorder may charge an additional fee of twenty dollars ($20.00). <br />Reproduced by First American Title Insurance 3/2003 <br />