EXHIBIT A
LESSORS' EXEMPTION CLAIM
(SAMPLE)
DON J. HUTCHINSON. ASSESSOR
MARSHALL S. ZAIDEL, CHIEF DEPUTY ASSESSOR
COUNTY OF ALAMEDA
1221 OAK ST., OAKLAND, CALIF. 94612
1978 LESSORS' EXEMPTION CLAIM
PROPERTY USED FOR FREE PUBLIC LIBRARIES AND FREE PUBLIC MUSEUMS
AND FOR PROPERTY USED EXCLUSIVELY FOR PUBLIC SCHOOLS,
COMMUNITY COLLEGES, STATE COLLEGES, STATE UNIVERSITIES,
CHURCHES, AND NONPROFIT COLLEGES.
SUBSECTIONS (d), (e) and (f) OF SECTION 3
OF THE CALIFORNIA CONSTITUTION
To receive the full exemption, this claim must be filed with the Assessor by March 15, 1977,
except that the church exemption claim must be filed by March 31, 1977
___________________________________________________________________________________________________states
NAME OF PERSON MAKING CLAIM
I. That as______________________________________________________________________________________________________________________
TITLE, SUCH AS PRESIDENT, ETC
2. Of the_______________________________________________________________________________________________________________________
CORPORATE NAME IF INCORPORATED
3. That claim for exemption is made on behalf of said organization for the 1977-1978 fiscal year for the properly listed below:
PROPERTY DESCRIPTION STATE PRIMARY AND INCIDENTAL USE
OF PROPERTY DESCRIBED
Land: Use:
Area:
Buildings and improvements: Use:
Personal Properly: Use:
Data Recorder/Card Controller Educational Use
4. That the name and address of the qualifying institution(s) is* Davis campus of the University of California
________________________________________________________________________________________________________________________
5. That the least confers upon the lessee the exclusive right to possession and use of the property except that for free public libraries and free
public museums the statute does not require "exclusive" USC.
6. That as used herein a qualifying institution is one hose property qualifies for the public school, community college, state college, state
university, free public library, free public museum, church, or nonprofit college property tax exemption.
7. That property included in this claim for exemption will [], will not [], be reported by the lessor on a business property statement submitted
the assessor (see the instructions for property statement filing requirements).
8. That an affidavit, in which the lessee declares it exclusively uses the property for exempt
purposes (check one) [] is attached, [] will be submitted
by the lessor with the property statement (for taxpayers required to file a property statement), [] will be submitted by the lessor by April
15 (for taxpayers not required to file a property statement).
Failure to submit the lessee's affidavit will result in denial of the exemption in cases of lessees which are public schools, community college:
state colleges, state universities, churches, and nonprofit colleges. Submission of the lessee's affidavit after the date specified will result
all or a portion of the exemption being denied.
I declare under penalty of perjury that the forgoing is true, correct, and complete to the best of my knowledge and belief and that all such
property is entitled to be exempt from taxation under the provisions of Article XIII of the California Constitution.
________________________________________________________________________________________ ____________________________________________
SIGNATURE OF PERSON MAKING CLAIM DATE
THIS EXEMPTION CLAIM IS A PUBLIC RECORD AND IS SUBJECT TO PUBLIC INSPECTION.
If there are numerous items of property at various locations, you may attach a list that clearly identifies the property, the name and address
the lessee, and which exemption is applicable.
SBE.ASD AH 263 FRONT 9-22-76 111-12-556-3 (1-77)
EXHIBIT A
(Continued)
LESSORS' EXEMPTION CLAIM - LESSEES' AFFIDAVIT
(SAMPLE)
INSTRUCTIONS
The person signing this claim should enter his name on the first line.
Line 3. If land and/or building, enter the street address and parcel number. If personal property,
describe in sufficient detail to identify (i.e., type, make, model, serial number, etc.). List
the primary use to be made of the property; list other known uses of the property.
Line 4. Enter the name and address of the lessee. If there is more than one lessee you may
attach an itemized list.
Line 7. Check the appropriate box. If you own taxable personal property in any county whose
aggregate cost is $30,000 or more, you must file a property statement with the assessor of
that county whether or not he requests you to do so. If the aggregate cost of the taxable
personal property is less than $30,000 you must return the property statement only if you
have received such a statement from the assessor.
Line 8. If the lessee is a public school, community college, state college, state university, church
or nonprofit college, you must submit evidence of the lessee's exclusive use of the property
for exempt purposes. Submit in accordance with the box checked on the form of affidavit
of the lessee declaring under penalty of perjury that the property is exclusively used
for the purpose for which exemption is conferred. In the case of free public library or
museum, exclusive use is not required, and the fact of the lessee's possession is
sufficient evidence of use.
Affidavit Form for Execution by
Institutional Lesses
State of California
County of YOLO Return to IBM Corporation
R. J. Frost hereby declares
NAME OF DECLARANT
1. That he or she is the Accounting Officer of Davis campus, University of Calif.
TITLE OR OFFICE NAME OF LESSEE INSTITUTION
2. That said institution is a State University
TYPE OF INSTITUTION, E.G. NONPROFIT PRIVATE COLLEGE
qualifying for property tax exemption and meets all requirements prescribed by law for exemption.
3. That said institution leases from IBM Corporation the following
NAME OF LESSOR
Personal property as of March 1 of this year;
REAL OR PERSONAL
a. Data Recorder/Card Controller
b. ______________________________________________________________________________________________
c. ______________________________________________________________________________________________
4. That this leased property is being used exclusively by this institution and exclusively for
Educational purposes.
EDUCATIONAL OR RELIGIOUS WORSHIP
Dated: 3/1/78 SIGNATURE OF DECLARANT
I declare under penalty of perjury that the foregoing is true, correct, and complete to the best of my knowledge and belief.
SBE.ASD AH 263 BACK 9-22-76 SIGNATURE OF DECLARANT