BOE-268-B

Source: https://www.boe.ca.gov/proptaxes/pdf/sample-boe268b.pdf

BOE-268-B (P1) REV. 12 (05-25) This page watermarked sample only. Contact Assessor for actual form. FREE PUBLIC LIBRARY OR FREE MUSEUM CLAIM PROPERTY USED SOLELY FOR EITHER A FREE PUBLIC LIBRARY OR FREE MUSEUM.

This claim is filed for fiscal year 20____ - 20____. (Example: a person filing a timely claim in January 2011 would enter "2011-2012.") This claim must be filed by 5:00 p.m., February 15. NAME AND MAILING ADDRESS (Make necessary corrections to the printed name and mailing address)

If you no longer seek an exemption at this location, check here Sign and return this form to the Assessor. Date vacated:

NAME OF PERSON MAKING CLAIM TITLE

NAME AND ADDRESS OF OWNER OF LAND AND BUILDINGS (if different from above) Form

NAME OF INSTITUTION

MAILING ADDRESS OF INSTITUTION (CITY, STATE, ZIP CODE) ONLY

ADDRESS OF PROPERTY (NUMBER AND STREET) ASSESSOR’S PARCEL NUMBERCITY, COUNTY, ZIP CODE ActualLEASE TERMINATION DATE

DAYS OF THE WEEK OPEN TO THE PUBLIC AND HOURS OF OPERATION for RCheck the type of qualifying exclusive use of the property. If filing for the first time, attach a copy of the lease or agreement. LIBRARY MUSEUM

1. Yes No Is admittance to the library or museum free? If no, please explain:

2. *Yes No If a library, is there a user charge for the use of books, periodicals, or facilities? SAMPLE

3. *Yes No If a museum, is there a charge for viewing the museum contents?

   *If yes, and a BOE-267, Claim for Welfare Exemption, has not been filed for the property, please contact the Assessor’s Assessor Office immediately. The deadline for timely filing a Claim for Welfare Exemption is February 15 each year. Where there is a
   user charge, a Claim for Welfare Exemption may be allowed if both the organization and the use of the property meet all of
   the requirements for the exemption.

4. Yes No Is the property, or a portion thereof, for which the exemption is claimed a bookstore that generates unrelated business taxable income as defined in section 512 of the Internal Revenue Code? If yes, a copy of the institution’s most recent tax return filed with the Internal Revenue Service must accompany this claim. Property taxes as determined by establishing a ratio of the unrelated business taxable income to the bookstore’s gross income will be levied. Contact

5. Yes No Is any of the owned property used for sales or business purposes other than a bookstore? If yes, please explain:

6. Yes No Is any equipment or other property at this location being leased or rented from someone else?

If yes, list in the remarks section the name and address of the owner and the type, make, model, and serial number of the property. "Exclusive use" is not required for this exemption, the lessee’s possession is sufficient evidence of use.

The benefit of a property tax exemption must inure to the lessee institution; the lessee may be entitled to claim a refund of taxes paid by the lessor. See section 202.2 of the Revenue and Taxation Code.

THIS DOCUMENT IS SUBJECT TO PUBLIC INSPECTION

This page watermarked sample only. Contact Assessor for actual form.

BOE-268-B (P2) REV. 12 (05-25)

7. List only property that is owned. Leased property may also be exempt if listed under the remarks section below. If leased property is listed, it is not necessary for the lessor to also claim the exemption on the Lessors’ Exemption Claim.

   PROPERTY DESCRIPTION STATE PRIMARY AND INCIDENTAL USE OF PROPERTY DESCRIBED

   Land: (Legal description or map book, page and parcel number Primary use: from most recent tax statement) Incidental use: Area: (Acres or square feet)

   Buildings and Improvements Primary use: Bldg. No. No. of No. of Type of or Name Floors Rooms Construction

   Incidental use: ONLYForm

   Personal Property: Describe - include cost and acquisition dates if Primary use: applicable. (Attach a separate sheet if necessary.) Actual Incidental use: for

REMARKS SAMPLE Assessor ContactWhom should we contact during normal business hours for additional information? NAME TITLE

DAYTIME TELEPHONE EMAIL ADDRESS ( ) CERTIFICATION I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing and all information herein, including any accompanying statements or materials, is true, correct, and complete to the best of my knowledge and belief. NAME OF PERSON MAKING CLAIM TITLE

SIGNATURE OF PERSON MAKING CLAIM DATE t