BOE-571-C

Source: https://www.boe.ca.gov/proptaxes/pdf/sample-boe571c.pdf

This page watermarked sample only. Contact BOE-571-C (P1) REV. 29 (07-25) Assessor for actual form. 2026 POWER PLANT PROPERTY STATEMENT (Declaration of costs and other related property information as of 12:01 A.M., January 1, 2026)

RETURN THIS ORIGINAL FORM. COPIES WILL NOT BE ACCEPTED. FILE RETURN BY APRIL 1, 2026.

SECTION 1. Name and Mailing Address Enter location of general ledger and all related accounting (Make necessary corrections to printed name mailing address) records (Include zip code)

Email Address

SECTION 2. Name and Type of Facility

Operational Date

Enter name and telephone number of authorized Main Parcel Number person to contact at location of accounting records Accounting/Location Code Phone Number ( ) Fax Number ( ) Appraisal Unit Code SECTION 3 COST ASSESSOR’SFormUSE ONLY FUEL FIX A. SUPPLIES NONFUEL O.I. TOTALB. CONSTRUCTION ONLYPP IN PROGRESS OUT OF COUNTY (attach listing) % COMPLETEC. PLANT AND EQUIPMENT IMP Actual

D. BUILDINGS, FIXTURES, LAND, AND LAND IMPROVEMENTS TOTAL SECTION 4 forAMOUNT ASSESSOR’S USE ONLY A. Expense B. Income SECTION 5 ITEM YES( X ) (NOX ) (NAX ) A. Do you use accrual basis accounting? SAMPLEB. Do you own the real estate?

C. Has all or part of the real estate been subject to a change of ownership since last filing?

D. If leased, is the real estate subject to an agreement of 35 years or more (including options) since last filing? Assessor E. Did another person or entity acquire “control” through acquisition of stock or otherwise since last filing? F. Was a new or amended power agreement enacted since last filing? (if yes, attach agreement or amendment) G. Was a new or amended steam or hot air agreement enacted since last filing? (if yes, attach agreement or amendment) H. Was a new or amended ash sales agreement enacted since last filing? (if yes, attach agreement or amendment) I. Was a new or amended fuel purchase agreement enacted since last filing? (if yes, attach agreement or amendment) J. Was a new or amended operation and maintenance agreement enacted since last filing? (if yes, attach agreement or amendment) DECLARATION BY ASSESSEE Contact OWNERSHIP TYPE Note: The following declaration must be completed and signed. If you do not do so, it may result in penalties. Proprietorship I declare under penalty of perjury under the laws of the State of California that I have examined this property statement, and that Partnership the foregoing and all information herein, including any accompanying statements or materials, is true, correct, and complete to the Corporation best of the taxpayer's knowledge and belief, and includes all property required to be reported which is owned, claimed, possessed, Other controlled, or managed by the person named as the assessee in this statement at 12:01 a.m. on January 1, 2026.

SIGNATURE OF ASSESSEE OR AUTHORIZED AGENT* DATE

NAME OF ASSESSEE OR AUTHORIZED AGENT* (typed or printed) TITLE

NAME OF LEGAL ENTITY (other than DBA) (typed or printed) FEDERAL EMPLOYER ID NUMBER

PREPARER’S NAME AND ADDRESS (typed or printed) TELEPHONE NUMBER TITLE ( ) *Agent: See page 12 for Declaration by Assessee instructions. THIS STATEMENT SUBJECT TO AUDIT

This page watermarked sample only. Contact Assessor for actual form.BOE-571-C (P2) REV. 29 (07-25)

2026 POWER PLANT PROPERTY STATEMENT

SECTION 6 — SCHEDULE OF SYSTEMS AND SUBSYSTEMS

A. FACILITY AND SPECIFICATIONS 1. Location (nearest population center): 2. Site Size (acres):

3. Nameplate Rating (Gross MWE):

4. Maximum Dependable Capacity (Gross MWE):

5. Maximum Dependable Capacity (Net MWE):
6. Fuel Used:

7. Fuel Requirements (units/hr): Form
8. Fuel Content (BTU/unit):

9. Heat Rate @ Maximum Load (BTU/KWH): 10. Cooling Water Requirement (ac-ft-yr): ONLY

11. Solid Waste Disposal (tons/yr):B. GENERATOR DATA Actual 1. Manufacturer: 2. Cumulative Hours on Line: for 3. Type of Cooling: 4. Number of Poles:

5. Rating (KVA):

6. Voltage:

7. Current (Amps): SAMPLE

C. TURBINE DATA a. GAS b. STEAM 1. Manufacturer: Assessor 2. Model Number and/or Designation

3. Number of Turbines/Number of Stages:

4. Steam/Demineralized Water Flow (lbs/hr):

5. Speed (rpm):

D. MAIN TRANSFORMER 1. Manufacturer: Contact 2. Type:

3. Rating (KV):

E. CONDENSER 1. Manufacturer:

2. Type:

3. Number of Cells:

4. Cooling Capacity:

This page watermarked sample only. Contact Assessor BOE-571-C (P3) REV. 29 (07-25) for actual form. 2026 POWER PLANT PROPERTY STATEMENT SECTION 7 — SCHEDULE OF INCOME INCOME MWH SOLD UTILITY INCOME NONUTILITY INCOME A. Energy Sales B. Ancillary Services 1. Regulation Income 2. Spinning Reserve Income 3. Nonspinning Reserve Income 4. Replacement Income C. Firm Capacity Income D. As-Available Capacity Income E. Capacity Bonus Income F. Dispatch/Curtailment Payment G. Production Tax Credit 1. Date PTC Eligibility Begins Date PTC Eligibility Ends Form 2. MW Capacity Eligible for PTC H. Steam Sales I. Hot Air SalesJ. Ash Sales ONLY K. Disposal L. Other Income (fully explain on attached sheet) Actual M. TOTAL INCOME SECTION 8 — SCHEDULE OF EXPENSES EXPENSES for Cost A. Labor and Employee Benefits B. Materials and Supplies (expensed items only) C. Plant Maintenance (normal) D. Contract Work and Rentals E. Insurance F. Solids Disposal SAMPLEVolume G. Water Supply 1. Volume 2. Supplier Assessor H. Operating Fuel Volume I. Fuel Transportation Charges (if separated from fuel costs) J. Fuel Taxes K. Other Utility Costs (fully explain on attached sheet) L. Electrical Transmission M. Haulage, Transportation, and Freight N. General and Administrative 1. Management Fees Contact 2. All other G & A Overhead (fully explain on attached sheet) O. Depreciation P. Interest Q. Property Tax, Federal Income Tax, State Income Tax, and Other Non-Payroll Taxes R. Major Overhaul or Turn-Around 1. Hours From Last Overhaul 2. Date Accomplished 3. Unit(s) Overhauled 4. Overhaul (O) or Hot Gas Path (H) S. Other Costs (fully explain on attached sheet) T. TOTAL EXPENSES PER ACCOUNTING RECORDS

This page watermarked sample only. Contact Assessor for actual form.BOE-571-C (P4) REV. 29 (07-25)

2026 POWER PLANT PROPERTY STATEMENT

SECTION 9 — MONTHLY POWER GENERATION, FUEL USAGE, AND OTHER OPERATIONAL INFORMATION
A. B. C. D. E. F. G.
GROSS NET (SALES) HOURS FACILITY FUEL CONSUMED BBL VOLUME OF VOLUME OF HEATED
GENERATION GENERATION FACILITY DISPATCH/ INDICATE UNIT OF STEAM SOLD OR AIR SOLD
MW HOURS MW HOURS ON LINE CURTAILMENT MEASURE (e.g., MCF) SELF USED INDICATE UNIT OF
HOURS FOR EOR MEASURE (e.g., MCF)
UOM COGENERATION ONLY UOM

Jan

Feb

Mar Apr

May

Jun Form Jul

Aug Sep ONLY

Oct Nov Actual

Dec

TOTAL for SECTION 10 — OTHER PRODUCTION INFORMATION A. Name of Energy Buyer

B. Date of Sales Contract

C. Type of Contracts / S.O. # / DurationD. Contract Capacity SAMPLE

E. Lien Date KW Price

F. Lien Date Fuel Price per Unit of Measure (e.g., MCF) Assessor G. Name of Heat / Steam Buyer

H. Lien Date Steam Price per BBL

SECTION 11 — PLANT OFF-LINE INFORMATION

MONTH SCHEDULED HOURS UNSCHEDULED HOURS REASON

A. B. Contact C.

D.

E.

F.

G.

H.

I.

This page watermarked sample only. Contact Assessor for actual form. BOE-571-C (P5) REV. 29 (07-25)

2026 POWER PLANT PROPERTY STATEMENT

SECTION 12 — SCHEDULE OF FIXED PLANT AND OTHER FIXED - MOVEABLE EQUIPMENT
C. OFFICE FURNITURE AND A. ELECTRIC PLANT AND FACILITY B. TEST AND REPAIR EQUIPMENT D. OFFICE COMPUTER EQUIPMENT

CAL EQUIPMENT YR ACQ COST ASSESSOR’S COST ASSESSOR’S COST ASSESSOR’S COST ASSESSOR’S USE ONLY USE ONLY USE ONLY USE ONLY

2025

2024

2023

2022 Form 2021

2020 2019 ONLY 2018 2017 Actual 2016

2015 for 2014

2013

2012 2011 2010 SAMPLE 2009

2008 Assessor 2007 2006

2005 2004

2003 2002 Contact 2001

2000

1999

Prior

TOTAL

This page watermarked sample only. Contact Assessor for actual form.BOE-571-C (P6) REV. 29 (07-25)

2026 POWER PLANT PROPERTY STATEMENT

SECTION 13 — SCHEDULE OF BUILDINGS, FIXTURES, LAND, AND LAND IMPROVEMENTS

A. NONPRODUCTION BUILDINGS B. FIXTURES C. LAND IMPROVEMENTS D. LAND ACQUISITIONS

CAL YR ACQ COST ASSESSOR’S COST ASSESSOR’S COST ASSESSOR’S COST ASSESSOR’S USE ONLY USE ONLY USE ONLY USE ONLY

2025 2024

2023

2022 Form 2021

2020

2019 ONLY 2018

2017 Actual 2016

2015 for 2014

2013

2012

2011

2010 SAMPLE 2009

2008 Assessor 2007

2006

2005

2004

2003

2002 Contact 2001

2000

1999

Prior

TOTAL

This page watermarked sample only. Contact Assessor for actual form. BOE-571-C (P7) REV. 29 (07-25)

2026 POWER PLANT PROPERTY STATEMENT

SECTION 14 — SCHEDULE OF ADDITIONS TO FIXED PLANT,
BUILDINGS, LAND, AND LAND IMPROVEMENTS
IN ASSET DESCRIPTION OF ADDITIONS DATE PRIOR YEAR COST ASSESSOR’S

SCHEDULE ACQUIRED CWIP USE ONLY A.

B.

C.

D.

E.

F.

G. Form H.

I.

J. ONLY SECTION 15 — SCHEDULE OF DELETIONS TO FIXED PLANT, BUILDINGS, LAND, AND LAND IMPROVEMENTS FROM ASSET ActualDATE YEAR ASSESSOR’S DESCRIPTION OF DELETIONS COST SCHEDULE DISPOSED ACQUIRED USE ONLY A.B. for

C.

D.

E.

F. SAMPLEG.

H.I. Assessor

J. SECTION 16 — DECLARATION OF PROPERTY BELONGING TO OTHERS — if none, write "NONE" (attach additional sheets in the same format if necessary)

(SPECIFY TYPE BY CODE NUMBER)

Report Conditional Sales Contracts in lines 6-9 as applicable DESCRIPTION COST TO

1. Leased Equipment 4. Vending Equipment YEAR OF YEAR OF AND LEASE OR PURCHASE ANNUAL
2. Leased-Purchase Option Equipment 5. Other Businesses ACQUISITION MANUFACTURE IDENTIFICATION NEW RENT
3. Capitalized Lease Equipment 6. Government-Owned Property • NUMBER Tax Obligation A. Lessor B. Lessee Contact • A. Lessor’s Name Mailing Address B. Lessor’s Name Mailing Address C. Lessor’s name Mailing Address D. Lessor’s Name Mailing Address E. Lessor’s Name Mailing Address F. Lessor’s Name Mailing Address G. Lessor’s Name Mailing Address

This page watermarked sample only. Contact BOE-571-C (P8) REV. 29 (07-25) Assessor for actual form.

INSTRUCTIONS

GENERAL INFORMATION

California law prescribes a yearly ad valorem tax based on property as it exists at 12:01 a.m. on January 1 (tax
lien date). This form constitutes an official request that you declare all assessable business property situated in
this county which you owned, claimed, possessed, controlled, or managed on the tax lien date, and that you sign
(under penalty of perjury) and return the statement to the Assessor’s Office by the date cited on the face of the
form as required by law. Failure to file the statement during the time provided in section 441 of the Revenue and
Taxation Code will compel the Assessor to estimate the value of your property from other information in the
Assessor’s possession and add a penalty of 10 percent of the assessed value as required by section 463 of the
Code.

If you own taxable personal property in any other county whose aggregate cost is $100,000 or more for any
assessment year, you must file a property statement with the Assessor of that county whether or not you are
requested to do so. Any person not otherwise required to file a statement shall do so upon request of
the Assessor regardless of aggregate cost of property. The Assessor of the county will supply you with a form
upon request. Form Except for the "DECLARATION BY ASSESSEE" section, you may furnish attachments in lieu
of entering the information on this property statement. However, such attachments must contain all
the information requested by the statement and these instructions. The attachments must be in a
format acceptable to the Assessor, and the property statement must contain appropriate references ONLY to the attachments and must be properly signed. In all instances, you must return the original BOE-571-C.

Include copies of the year-end profit and loss statement, the current year’s budget, most current income and expense forecast (pro forma), your major repair schedule with costs,Actualand a description of work to be performed.

THIS THIS STATEMENT IS NOT IF ANY SITUATION EXISTS WHICH
STATEMENT A PUBLIC DOCUMENT. THE NECESSITATES A DEVIATION
IS SUBJECT INFORMATION DECLARED FROM TOTAL COST PER BOOKS for
TO AUDIT. WILL BE HELD SECRET BY THE AND RECORDS, FULLY EXPLAIN
ASSESSOR. ALL ADJUSTMENTS.

SECTION 1

Enter your (assessee) name, attention or care of, and mailing address. Provide the name, telephone and fax numbers of the person to contact regarding the information in the return. Also, enter the location of the general ledger and all related accounting records; include the zip code with the address. SAMPLE SECTION 2

Provide the facility name, type or nature of the facility (e.g.; coal, geothermal, natural gas, bio-mass, gas fired Assessor cogeneration, wood chip cogeneration, and coal fired cogeneration), and the date the facility went into commercial
operation. Next, enter the Assessor’s parcel number, your accounting or location code, and appraisal unit code
as provided by the Assessor (leave blank if not known).

SECTION 3

Supplies — Provide the cost for fuel and nonfuel supplies on hand at lien date. Report actual or estimated
amounts in whole dollars. There are a variety of methods for estimating supplies of which two are discussed. The
first method is based on capacity. You have a capacity for storing 15,000 gallons of unleaded gasoline. Your last fuelContactdelivery cost $1.35 per gallon. At any given time, you reasonably believe the tanks are 30 percent full. The
estimate of fuel on hand, in this case, is $6,075 (15,000 x .30 x 1.35 = 6075). The other method is based on time.
The total office supply expense for the year was $15,000. Your experience indicates you have 1.5 months of
supplies on hand at any given time. The estimate of office supplies, in this case, is $1,875 (15,000 x
(1.5/12) = 1875.

Construction in Progress — Report the expenditures for equipment and other projects under construction not
placed into service as of lien date. Report actual or estimated amounts in whole numbers. Acceptable methods for
reporting cost are: (1) percentage complete times the authorization for expenditure (AFE), budgeted, or contract
amounts; and (2) actual expenditure to date. If a project is to be allocated to other appraisal units, you are required
to provide the allocated amounts. Separately report personal property (moveable equipment); fixtures and fixed
plant/equipment; and buildings and land improvements.

This page watermarked sample only. Contact BOE-571-C (P9) REV. 29 (07-25) Assessor for actual form.

Plant and Equipment — Enter the total cost of all plant and other equipment from the Plant & Equipment
Schedule(s) attached.

Buildings, Fixtures, Land, and Land Improvements Total — Enter the total cost of all buildings, fixtures, land,
and land improvements from the Buildings, Fixtures, Land, and Land Improvements Schedule(s) attached.

SECTION 4

Enter the total expenses and income reported from Sections VII and VIII of the property statement.

SECTION 5

Answer the listed questions and statements by checking the appropriate box: Yes, No, or NA (not applicable).
(Note that some items may require additional information depending on the answer.)

SECTION 6

Report all system and subsystem data. If there are subsystems not listed, report these on a separate schedule.
Enter "NA" for items that are not appropriate. Form

SECTION 7

Income — Enter the gross income for the categories listed for the calendar year preceding lien date. Report megawatt hours sold for the applicable categories of income.ONLYFor each category, enter the income from utility and
nonutility company sources. If the power plant is eligible to receive a Production Tax Credit as a result of the Energy
Policy Act of 2005, enter the amount of the credit received in the prior calendar year as nonutility income. Also report the date PTC eligibility begins and when it will terminate. Lastly,Actualenter the amount of megawatts capacity
subject to this eligibility. Attach a separate schedule detailing “Other Income.” SECTION 8 for

Expenses — Enter direct operating expenses only for the calendar year preceding the lien date. Do not include
capitalized items such as labor and benefits capitalized as part of plant and equipment acquisitions. Attach a
separate schedule fully detailing "Other Costs."

SECTION 9 Enter monthly powerSAMPLEgeneration, fuel usage and other operational information for the calendar year preceding lien
date. Report gross generation as megawatt hours. The net generation is the amount of electricity sold or wheeled
after all parasitic and other loads have been accounted for. Report the hours the plant was generating electricity; even if there was no net salesAssessoror operations were at a reduced (curtailed) level. Provide the amount of fuel used
during the month, and indicate unit of measure; for example, tons or mcf as shown in the form. For cogeneration
plants selling or transferring steam, report the amount of steam produced in barrels (BBL): no other unit of measure
is acceptable. Report the amount of heated air sold in mcf. Finally, total each column for the year’s total.

SECTION 10

Enter other production related information. Provide the energy buyer’s name(s). Indicate the date of the sales contract and dates involving renegotiation of the price per unit of energy production. Specify the type of contract andContactduration, and the Standard Offer contract number if applicable; for example, S.O.4/20 years. Report the lien date price per KWH excluding capacity and bonus increments. Provide the lien date price for fuel including transportation charges: for example; price per mcf of gas, or price per ton of coal. Enter the name of the buyer(s) of the heated air or steam, or "Self Consumed" if not sold. Indicate the lien date selling price per barrel (BBL), or the internal accounting charge if self consumed.

SECTION 11

Enter plant production curtailed or off-line for periods greater than 24 hours during the month. Provide the month, the hours off-line and a brief explanation; for example, turbine failure.

This page watermarked sample only. Contact Assessor for BOE-571-C (P10) REV. 29 (07-25) actual form.

SECTIONS 12 and SECTION 13

These sections are for reporting costs, in whole dollars, summarized by calendar year of acquisition plant and
other fixed - moveable equipment; and buildings, fixtures, land and land improvements respectively. Attach as
many schedules as needed to cover all reportable assets and property.

The first column is for entering the calendar year. The box above the "Cost" and "Assessor’s Use Only" is for
indicating the type of property being reported; for example, generation plant, computer equipment, office furniture
and equipment, and fixtures. The "Cost" column is for entering the summarized cost for the calendar year. For
each group, remember to total the cost.

Reportable cost includes the purchase price, sales and use taxes, transportation, installation and construction
charges, interest during construction, and other expenses to place the asset into service. The reportable cost
does not include adjustments for gain or loss on trade-in, adjustment for investment tax credit, section 179
deduction, or other tax or accounting adjustments. Items previously leased are reported at their original full cost
and acquisition date. Do not include fully licensed vehicles and trailers, and off-highway vehicles subject to
identification (trail bikes, snowmobiles, and 3- and 4-wheel all-terrain vehicles). The property tax is paid via the
annual registration and off-highway identification sticker. However, you must report oversized and overweight
rubber-tired vehicles, except commercial vehicles and cranes, requiring permits issued by the Department of Form

Transportation to operate on the highways. Unlicensed vehicles and equipment with license plates starting with
"SE" are to be reported. Do not include pipelines and rights-of-way because they are reported on separate ONLY
property statements. If you have facilities and plants that are being allocated to other appraisal units, you are
required to provide the allocated cost: we will not perform the allocation. Do not include application software costs
in accordance with section 995.2 of the Revenue and Taxation Code. Actual

Group the assets according to function. This may follow your accounting classification policy. Some general
guidelines to grouping assets are: for
• Computer equipment and office equipment/furniture should be reported separately.

• Computers, buildings, and land improvements which are an integral part of a facility or plant are to be
combined with the equipment into a single category.

• Tanks having a capacity of 5,000 bbl or more are to be reported separately from tanks of lesser capacity. SAMPLE • Categories or groups may be combined into one group if the Assessor uses the same value method, percentage of improvements, and classification for the individual groups: for example; AWT’s, LACT’s, BSW’s, monitors, and gauging equipment. However, active and idle equipment must be split into separate groups:Assessorfor example; active steam generators and injection systems, and idle steam generators and injection systems.

The following are some of the errors and unacceptable practices found to be most common during annual review of the property statement.

• Do not report negative numbers. They are ignored and treated as zero amounts.

• Do not classify major plant and equipment as "Miscellaneous Equipment"; otherwise, this category is

treated as personal property or fixtures regardless of the dollar amount reported. Contact • Do not determine new acquisitions by reporting the difference between last year’s and this year’s account balances. All new acquisitions are reported as current year. Disposals are to be deleted from the appropriate year, or be deleted from the oldest reported amount in the prior year.

• Separately report active and idle assets of the same classification. You may determine the actual cost

by acquisition year, or prorate the total group based on a single percentage for all acquisition years.

• Fully depreciated items still in use (active or idle) must be reported.

• Remember to incorporate finalized property tax audit adjustments as part of the reported information.

This page watermarked sample only. Contact Assessor for actual form. BOE-571-C (P11) REV. 29 (07-25)

SECTION 14

List additions that occurred from the last filing. Do not include personal (moveable) property and fixtures. Include
fixed plant, buildings, land, and land improvements. Provide the name of the asset schedule in which the item is
reported, an item description, the date acquired or completion date, and the cost. Also provide the amount of
prior year, reported construction in progress (CWIP). Reportable cost includes the purchase price, sales and use
taxes, transportation, installation and construction charges, interest during construction, and other expenses
incurred to place the asset into service. The reportable cost does not include adjustments for gain or loss on
trade-in, adjustment for investment tax credit, section 179 deduction, or other tax or accounting adjustments. Only
completed projects should be reported as of the date the property becomes functional or operational; otherwise,
the item should be reported as construction in progress.

SECTION 15

List deletions that occurred from the last filing. Do not include personal (moveable) property and fixtures. Include
fixed plant, buildings, land, and land improvements. Provide the name of the asset schedule in which the
item was reported in the prior year, an item description, disposal date, the date acquired or completion date, and the cost. Form

SECTION 16

If property belonging to others, or their business entities, is located on your premises, report the owner’s name and mailing address. If it is leased equipment, read your agreementONLYcarefully and enter A (Lessor) or B (Lessee),
and whether lessor or lessee has the tax obligation. For assessment purposes, the Assessor will consider, but is
not bound to, the contractual agreement. Actual
1. LEASED EQUIPMENT. Report the year of acquisition, the year of manufacture, description of the leased
property, the lease contract number or other identification number, the total installed cost to purchase
(including sales tax), and the annual rent; do not include in schedules for property belonging to you (see for
No. 3 below).

2. LEASE-PURCHASE OPTION EQUIPMENT. Report here all equipment acquired on lease-purchase
option on which the final payment remains to be made. Enter the year of acquisition, the year of
manufacture, description of the leased property, the lease contract number or other identification number,
the total installed cost to purchase (including sales tax), and the annual rent. If final payment has
been made, report full cost and original year of acquisition in schedules for property belonging to you SAMPLE (see No. 3 below).

3. CAPITALIZED LEASED EQUIPMENT. Report here all leased equipment that has been capitalized at
the present value of the minimum lease payments on which a final payment remains to be made. Enter Assessor
the year of acquisition, the year of manufacture, description of the leased property, the lease contract
number or other identification number, and the total installed cost to purchase (including sales tax). Do
not include in schedules for property belonging to you unless final payment has been made.

4. VENDING EQUIPMENT. Report the model and description of the equipment; do not include in schedules
for property belonging to you unless you actually own the equipment.

5. OTHER BUSINESSES. Report other businesses on your premises. Contact6. GOVERNMENT-OWNED PROPERTY. If you possess or use government-owned land, improvements,
or fixed equipment, or government-owned property is located on your premises, report the name and
address of the agency which owns the property, and a description of the property.

This page watermarked sample only. Contact Assessor for actual form.BOE-571-C (P12) REV. 29 (07-25)

DECLARATION BY ASSESSEE

The law requires that this property statement, regardless of where it is executed, shall be declared to be true under
penalty of perjury under the laws of the State of California. The declaration must be signed by the assessee, a
duly appointed fiduciary, or a person authorized to sign on behalf of the assessee. In the case of a corporation,
the declaration must be signed by an officer or by an employee or agent who has been designated in writing by
the board of directors, by name or by title, to sign the declaration on behalf of the corporation. In the case of a
partnership, the declaration must be signed by a partner or an authorized employee or agent. In the case of a
Limited Liability Company (LLC), the declaration must be signed by an LLC manager, or by a member where
there is no manager, or by an employee or agent designated by the LLC manager or by the members to sign on
behalf of the LLC.

When signed by an employee or agent, other than a member of the bar, a certified public accountant, a public
accountant, an enrolled agent or a duly appointed fiduciary, the assessee’s written authorization of the employee
or agent to sign the declaration on behalf of the assessee must be filed with the Assessor. The Assessor may at
any time require a person who signs a property statement and who is required to have written authorization to
provide proof of authorization. Form
A property statement that is not signed and executed in accordance with the foregoing instructions is not validly
filed. The penalty imposed by section 463 of the Revenue and Taxation Code for failure to file is applicable to
unsigned property statements. ONLY Actual
for SAMPLE Assessor

Contact