PRELIMINARY CHANGE OF OWNERSHIP REPORT		
	FOR RECORDER’S USE ONLY	
To be completed by transferee (buyer) prior to transfer of subject property in accordance with Section 480.03 of the Revenue and Taxation Code.  A Preliminary Change of Ownership Report must be filed with each conveyance in the County Recorder's office for the county where the property is located; this particular form may be used in all 58 counties of California.
THIS REPORT IS NOT A PUBLIC DOCUMENT
			
SELLER/TRANSFEROR:   		
BUYER/TRANSFEREE:  		
ASSESSOR'S PARCEL NUMBER(S)   		
PROPERTY ADDRESS OR LOCATION:		

MAIL TAX INFORMATION TO:  		
	Name			
	Address			

	
NOTICE:  A lien for property taxes applies to your property on March 1 of each year for the taxes owing in the following fiscal year, July 1 through June 30.  One-half of these taxes is due November 1, and one-half is due February 1.  The first installment becomes delinquent on December 10, and the second installment becomes delinquent on April 10.  One tax bill is mailed before November 1 to the owner of record.  IF THIS TRANSFER OCCURS AFTER MARCH 1 AND ON OR BEFORE DECEMBER 31, YOU MAY BE RESPONSIBLE FOR THE SECOND INSTALLMENT OF TAXES DUE FEBRUARY 1.
The property which you acquired may be subject to a supplemental assessment in an amount to be determined by the [      ] County Assessor.  For further information on your supplemental roll obligation, please call the [      ] County Assessor at 408/299-4781.
	
PART I:  TRANSFER INFORMATION	Please answer all questions.

YES	NO
		A.	Is this transfer solely between husband and wife (Addition of a spouse, death of a spouse, divorce settlement, etc.)?
		B.	Is this transaction only a correction of the name(s) of the person(s) holding title to the property (For example, a name change upon marriage)?
		C.	Is this document recorded to create, terminate, or reconvey a lender's interest in the property?
		D.	Is this transaction recorded only to create, terminate, or reconvey a security interest (e.g. cosigner)?
		E.	Is this document recorded to substitute a trustee under a deed of trust, mortgage, or other similar document?
		F.	Did this transfer result in the creation of a joint tenancy in which the seller (transferor) remains as one of the joint tenants?
		G.	Does this transfer return property to the person who created the joint tenancy (original transferor)?
		H.	Is this transfer of property:
		1.  to a trust for the benefit of the grantor, or grantor's spouse?
		2.  to a trust revocable by the transferor?
		3.  to a trust from which the property reverts to the grantor within 12 years?
		I.	If this property is subject to a lease, is the remaining lease term 35 years or more including written options?
		J.	Is this a transfer from parents to children or from children to parents?
		K.	Is this transaction to replace a principal residence by a person 55 years of age or older?
		L.	Is this transaction to replace a principal residence by a person who is severely disabled as defined by Revenue and Code Section 69.5?

If you checked yes to J, K, or L, an applicable claim form must be filed with the County Assessor.
Please provide any other information that would help the Assessors to understand the nature of the transfer.

IF YOU HAVE ANSWERED "YES" TO ANY OF THE ABOVE QUESTIONS EXCEPT J, K, OR L, PLEASE SIGN AND DATE,
OTHERWISE COMPLETE BALANCE OF THE FORM.
	
PART II:  OTHER TRANSFER INFORMATION
A.	Date of transfer if other than recording date [              ].
B.	Type of transfer.  Please check appropriate box.
  Purchase	  Foreclosure	  Gift	  Trade or Exchange	  Merger, Stock, or Partnership Acquisition
  Contract of Sale - Date of Contract [              ]
  Inheritance - Date of Death [              ]	  Other:  Please explain:  [              ]
  Creation of Lease	  Assignment of a Lease	  Termination of a Lease
Date lease began [              ]
Original term in years (including written options) [              ]
Remaining term in years (including written options) [              ]
C.	Was only a partial interest in the property transferred?     Yes       No     If yes, indicate the percentage transferred  _______%

PRELIMINARY CHANGE OF OWNERSHIP REPORT
Please answer, to the best of your knowledge, all applicable questions, sign and date.  If a question does not apply, indicate with "N/A."
	
PART III:  PURCHASE PRICE AND TERMS OF SALE

A.	CASH DOWN PAYMENT OR Value of Trade or Exchange (excluding closing costs)	Amount $[         ]	
B.	FIRST DEED OF TRUST @ [       ]% interest for [          ] years.  Pymts/Mo.=$[         ]	 (Prin. & Int. only)  Amount $[         ]	
  FHA	  Fixed Rate	  New Loan
  Conventional	  Variable Rate	  Assumed Existing Loan Balance
  VA	  All inclusive D.T. ($[         ]	 Wrapped)	  Bank or Savings & Loan
  Cal-Vet	  Loan Carried by Seller	  Finance Company
Balloon Payment	  Yes	  No	Due Date [         ]	  Amount $[         ]	
B.	SECOND DEED OF TRUST @ [       ]% interest for [          ] years.  Pymts/Mo.=$[         ]	 (Prin. & Int. only)  Amount $[         ]	
  Bank or Savings & Loan	  Fixed Rate	  New Loan
  Loan Carried by Seller	  Variable Rate	  Assumed Existing Loan Balance
Balloon Payment	  Yes	  No	Due Date [         ]	  Amount $[         ]	
D.	OTHER FINANCING:  Is other financing involved not covered in (b) or (c) above?	  Yes	  No	Amount $[         ]	
Type:  [              ] @ [       ]% interest for [         ] years. Pymts./Mo .= $[         ]	 (Prin. & Int. only)
  Bank or Savings & Loan	  Fixed Rate	  New Loan
  Loan Carried by Seller	  Variable Rate	  Assumed Existing Loan Balance
Balloon Payment	  Yes	  No	Due Date  [         ]	  Amount $[              ]	
E.	IMPROVEMENT BOND	  Yes	  No	Outstanding Balance:  	Amount $[         ]	
F.	TOTAL PURCHASE PRICE (or acquisition price, if traded or exchanged, include real estate commission if paid.)
Total Items A through E $[         ]	
G.	PROPERTY PURCHASED	  Through a broker	  Direct from seller	  Other (explain)	

If purchased through a broker, provide broker's name and phone number:  [          ]	

Please explain any special terms or financing and any other information that would help the Assessor understand the purchase price and terms of sale.

	
PART IV:  PROPERTY INFORMATION
A.	IS PERSONAL PROPERTY INCLUDED IN PURCHASE PRICE
(other than a mobilehome subject to local property tax)? 	   Yes	   No
If yes, enter the value of the personal property included in the purchase price $[         ]	 (Attach itemized list of personal property).
B.	IS THIS PROPERTY INTENDED AS YOUR PRINCIPAL RESIDENCE? 	   Yes	   No
If yes, enter date of occupancy                   /                   /                 or intended occupancy                    /                   /                .
Month	Day	Year	Month	Day	Year
C.	TYPE OF PROPERTY TRANSFERRED:
  Single-family residence	  Agricultural	  Timeshare
  Multiple-family residence (no. of units:  [         ]	)	  Co-op/Own-your-own	  Mobilehome
  Commercial/Industrial	  Condominium	  Unimproved lot
  Other (Description:  [         ]	)
D.	DOES THE PROPERTY PRODUCE INCOME? 	  Yes	  No
E.	IF THE ANSWER TO QUESTION D IS YES, IS THE INCOME FROM:
  Lease/Rent	  Contract	  Mineral Rights	  Other - Explain:  [               ]	
F.	WHAT WAS THE CONDITION OF PROPERTY AT THE TIME OF SALE?
  Good	  Average	  Fair	  Poor
Enter here, or on an attached sheet, any other information that would assist the Assessor in determining the value of the property such as the physical condition of the property, restrictions, etc.
[       ]	
[       ]	

I certify that the foregoing is true, correct and complete to the best of my knowledge and belief.

Signed 	  Dated 	
NEW OWNER/CORPORATE OFFICER

Please Print Name of New Owner/Corporate Officer [       ]	

Phone Number where you are available from 8:00 a.m. - 5:00 p.m. [        ]	
(NOTE:  The Assessor may contact you for further information)
	
If a document evidencing a change of ownership is presented to the recorder for recordation without the concurrent filing of a preliminary change of ownership report, the recorder may charge an additional recording fee of twenty dollars ($20).