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BOE-502-A (Back) Rev. 5 (8-03) <br />`PRELIMINARY CHANGE OF OWNERSHIP REPORT <br />File No. 0131-611961ala (MC) <br />I <br />Please answer, to the best of your know/edge, all applicable questions, then sign and date. If a question does not apply, indicate with 'NIA.' <br />PART III: PURCHASE PRICE & TERMS OF SALE <br />A. CASH DOWN PAYMENT OR Value of Trade or Exchange (excluding closing cost) Amount: <br />B. FIRST DEED OF TRUST @ % Interest for years. Payments/Mo=$ (Prin. & I .) Amount: <br />[ ]FHA [ ]Fixed Rate [�Nc�anConventionalVariable Rate edExisting Loan Balance <br />]VA [ ] All Inclusive D.T. ($ Wrapped) [r Savings & Loan <br />[ ] Cal -Vet [ J 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 cov d in (B) and (C) above? [ ] Yes [ ] No Amount: <br />Type % Interest for yea ayments/Mo=$ (Prin. & Int. only) <br />( ]Bank or Savings &Loan [ ] F d Rate [ ]New Loan <br />[ j Loan Carried by Seller [ Variable Rate [ ] Assumed Existing Loan Balance <br />Balloon Payment [ ] Yes [ ] N ue Date Amount: <br />E. WAS AN IMPROVEMENT BOND SUMED BY THE BUYER? [ ] Yes [ ] No Outstanding Balance: Amount: <br />F. TOTAL PURCHASE PRICE acquisition price, if traded or exchanged, include real estate commission if paid) <br />Total Items A through E <br />G. PROPERTY PURCHASED [ ] Through a broker [ ] Direct from seller [ ] From a family member [ ] Other (please explainj. <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. <br />B. <br />C. <br />D. <br />E. <br />F. <br />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 />[ ] Commercial/Industrial [ ] Condominium [ ] Unimproved lot <br />[ ] Other (Description: i.e., timber, mineral, water rights, etc. <br />IS THIS PROPERTY INTENDED AS YOUR PRINCIPAL RESIDENCE? [ ] Y [ ] No <br />If yes, enter date of occupancy / / or intended occupancy <br />month day year month day year <br />IS PERSONAL PROPERTY INCLUDED IN PURCHASE PRICE '.., furniture, farm equipment, machinery, etc.) <br />(other than a manufactured home subject to local pro tax?) [ ] Yes [ J No <br />If yes, enter the value of the personal property i ded in the purchase price $ (Attach itemized list ofpersona/property.) <br />IS A MANUFACTURED HOME INCLUDED PURCHASE PRICE? [ ] Yes [ ] No <br />If yes, how much of the purchase p . is allocated to the manufactured home? $ <br />Is the manufactured home subj o local property tax? [ ] Yes [ ] No What is the decal number? <br />DOES THE PROPERTY PRO CE INCOME? [ ] Yes [ ] No If yes, is the income from: <br />[ ] Lease/Rent [ Contract [ ] Mineral Rights [ ] Other (please explain): <br />WHAT WAS THE DITION OF PROPERTY AT THE TIME OF SALE? <br />[ ] Good [ ] Average [ ] Fair [ ] 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 (check) <br />Proprietorship [ ] <br />Partnership [ ] <br />I certify that the foregoing is true, correct and complete to the best of my know/edge and belief. <br />Corporation [ ] <br />This declaration is binding on each and every co-owner and/or partner. <br />Other .` L .by <br />NAME OF TRANSFEREE OR OFFICER OF TRANSFEREE (typed or printed) <br />TITLE <br />J v1n vt 2 � vhG,1n i <br />- <.C.tti-ive. D � f�2 C+pi <br />SIGNA 0 NS R-SFFIGER-0E-RAN5F.FREE <br />ATE <br />�1 (typed -printed) <br />LA S %A Le A-,dvo Z"9-VR a MC-Wt A�CVI <br />FEDERAL EMPLOYER ID NUMBER <br />Q4- o0 QLA 21 <br />ADDRESS iltyoed or printed) <br />9:35 �-. LA1"` i-. Sa.v► L-Cardy-o <br />LE HONE NUMBER <br />DATE <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 riling 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 />