BOE-266-E

Source: https://www.boe.ca.gov/proptaxes/pdf/sample-boe266e.pdf

This page watermarked sample only. Contact Assessor for actual form. BOE-266-E (P1) REV. 02 (07-25)

OWNERSHIP STATEMENT COOPERATIVE HOUSING CORPORATION This statement represents a written request from the Assessor. Failure to file will result in the assessment of a penalty. FILE THIS STATEMENT BY FEBRUARY 1.

NAME AND MAILING ADDRESS (Make necessary corrections to the printed name and mailing address) Form

PROPERTY STREET ADDRESS ASSESSOR’S PARCEL NUMBERCITY ONLYZIP CODE OWNERSHIP INFORMATION.Actual

Attach a listing that provides: for 1. the full name and mailing address of each owner, stockholder, or holder of an ownership interest; 2. a copy of the stock certificate or other document that evidences an interest in the unit or lot; 3. the situs address, including the number, of each unit or lot; 4. the date that an ownership interest was acquired and the acquisition price of that interest; 5. which of the shareholders or members resided in the designated dwelling units on the lien date.

Copies of stock certificates and other documents evidencing an interest in an individual unit or lot that were provided to the SAMPLEAssessor in a previous ownership report are not required to be provided in subsequent ownership reports. Assessor

This statement must be filed on or before the first February 1 following an Assessor request, and on or before each February 1 thereafter. Failure to file the ownership statement, shall result in a penalty described in Revenue and Taxation Code section 482 for each individual unit or lot whose owner or shareholder fails to independently file the change in ownership statement.

CERTIFICATION

I certify (or declare) under penalty of the laws of the State of California that the foregoing, and all information Contact herein, is true, correct, and complete to the best of my knowledge and belief.

Additionally, if this form is submitted with an electronic signature, I also 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. SIGNATURE OF CORPORATE OFFICER DATE t NAME OF CORPORATE OFFICER TITLE

EMAIL ADDRESS DAYTIME TELEPHONE NUMBER ( ) THIS DOCUMENT IS SUBJECT TO PUBLIC INSPECTION