BOE-571-R (P1) REV. 22 (05-19)
APARTMENT HOUSE PROPERTY
STATEMENT FOR 2020
(Declaration of costs and other related
property information as of 12:01 A.M.,
January 1, 2020)
RETURN THIS ORIGINAL FORM. COPIES WILL NOT BE ACCEPTED.
FILE RETURN BY APRIL 1, 2020
NAME AND MAILING ADDRESS
(Make necessary corrections to the printed name and mailing address.)
Local Telephone Number Fax Number
Email Address
Enter location of general ledger and all related accounting records (include zip code):
STREET CITY STATE ZIP
Enter name and telephone number of authorized person to contact at location of accounting records:
CAREFULLY READ AND FOLLOW THE ACCOMPANYING INSTRUCTIONS.
1. If you no longer own this property as of January 1 of this year, show the name and mailing address of the new
owner:
Name
Mailing Address
City and State Zip Code
LOCATION OF THE PROPERTY (street, city)
(le a separate statement for each location)
2. Enter the total number of units for the location listed.
Do you live in one of the units?
Yes No
If yes, enter the unit number
3. During the period of January 1, 2019 through December 31,
2019:
(1) Did any individual or legal entity (corporation, partnership,
limited liability company, etc.) acquire a "controlling
interest" (see instructions for definition) in this business
entity?
Yes No
(2) If YES, did this business entity also own "real property" (see
instructions for denition) in California at the time of the
acquisition?
Yes No
(3) If YES to both questions (1) and (2), ler must submit form
BOE-100-B, Statement of Change in Control and Ownership
of Legal Entities, to the State Board of Equalization. See
instructions for ling requirements.
4. Do any other individuals, partnerships or corporations do business or own personal property (other than household furniture and personal effects of your tenants) located on your
premises? Yes No If yes, list below.
NAME AND ADDRESS OF OWNER OF SUCH PROPERTY NATURE OF THE BUSINESS OR PROPERTY
ASSESSOR’S
USE ONLY
5. Do you hold furniture or equipment belonging to others on a loan, rental, or lease basis?
Yes No If yes, list below.
NAME AND ADDRESS OF OWNER OF SUCH PROPERTY QUANTITY AND DESCRIPTION
6. ENTER BELOW the number of fully furnished, partly furnished (e.g., stoves and refrigerators, not built-in), and unfurnished units. Also complete
Schedule A. Do not include, either here or in Schedule A, any unit in which you live.
SLP. ROOM STUDIO 1 BEDRM. 2 BEDRM. 3 BEDRM. LARGER
FULLY FURNISHED
PARTLY FURNISHED
UNFURNISHED
TOTALS
7. Supplies Cost
8. Furniture and appliances Enter From Schedule A
9. Other furniture and equipment Enter From Schedule B
10.
TOTAL FULL VALUE
PERSONAL PROPERTY
FIXTURES
OTHER IMPROVEMENTS
LAND
THIS STATEMENT SUBJECT TO AUDIT
BOE-571-R (P2) REV. 22 (05-19)
SCHEDULES OF DEPRECIABLE PROPERTY — SCHEDULES A and B. Items may be listed separately within the year of acquisition on
a separate schedule, or items may be grouped by year of acquisition and listed on the schedules below. If you purchased the property as a
unit, report on Schedules A & B the previous owner’s original cost by the original year of acquisition of the furniture and equipment that was
included in your purchase.
Enter the total installed cost including freight, excise taxes, and sales and use taxes of all furniture, and other equipment located on the
premises. Include fully depreciated items. Do not include licensed vehicles. Depreciation schedules may be attached if they provide the
desired information.
FURNITURE AND APPLIANCES (include items in storage;
OTHER FURNITURE AND EQUIPMENT (ofce, lobby, laundry,
SCHEDULE B
pool, vending, signs, re extinguishers)
SCHEDULE A
do not include built-ins)
Year of
Acquisition
Original Installed Cost
(NOT depreciated book value)
FOR ASSESSOR’S USE ONLY
Year of
Acquisition
Original Installed Cost
(NOT depreciated book value)
FOR ASSESSOR’S USE ONLY
Factor Value
Factor Value
2019
2019
2018
2018
2017
2017
2016
2016
2015
2015
2014
2014
2013
2013
2012
2012
2011
2011
2010
2010
2009
& prior
2009
& prior
TOTAL COST $
Enter on line 8, page 1.
TOTAL COST $
Enter on line 9, page 1.
SIGNATURE OF ASSESSEE OR AUTHORIZED AGENT*
DATE
NAME OF ASSESSEE OR AUTHORIZED AGENT* (typed or printed)
Proprietorship
t
TITLE
NAME OF LEGAL ENTITY (other than DBA) (typed or printed) FEDERAL EMPLOYER ID NUMBER
Partnership
Corporation
PREPARER’S NAME AND ADDRESS (typed or printed) TELEPHONE NUMBER TITLE
Other
( )
REMARKS:
DECLARATION BY ASSESSEE
Note: The following declaration must be completed and signed. If you do not do so, it may result in penalties.
I declare under penalty of perjury under the laws of the State of California that I have examined this property statement, including accompanying schedules,
statements or other attachments, and to the best of my knowledge and belief it is true, correct, and complete and includes all property required to be
reported which is owned, claimed, possessed, controlled, or managed by the person named as the assessee in this statement at 12:01 a.m. on January 1,
2020.
OWNERSHIP
TYPE (R)
*Agent: See page 3 for Declaration by Assessee instructions.
BOE-571-R (P3) REV. 22 (05-19)
INSTRUCTIONS
The Revenue and Taxation Code of the State of California requires that every person, upon request of the Assessor, shall
le a written property statement under penalty of perjury with the Assessor within such time as the Assessor may appoint.
Please complete this form according to the numbered instructions provided below as your statement of furnishings and related
equipment owned, possessed or controlled by you as of 12:01 a.m., January 1, this year at the location listed. Property which you
are purchasing under a conditional sales contract must be included. Return the completed statement form to the Assessor
on or before the date stated in the ofcial requirement section. In all instances, you must return the original BOE-571-R.
LINE 3. PROPERTY TRANSFER
Real Property – For purposes of reporting a change in control, real property includes land, structures, or xtures owned or held
under lease from (1) a private owner if the remaining term of the lease exceeds 35 years, including written renewal options, (2) a
public owner (any arm or agency of local, state, or federal government) for any term or (3) mineral rights owned or held on lease
for any term, whether in production or not.
Controlling Interest – When any person or legal entity obtains more than 50 percent of the voting stock of a corporation, or more
than a 50 percent ownership interest in any other type of legal entity. The interest obtained includes what is acquired directly or
indirectly by a parent or afliated entity.
Forms, Filing Requirements & Penalty Information – Contact the Legal Entity Ownership Program Section at
916-274-3410 or refer to the Board’s website at www.boe.ca.gov to obtain form BOE-100-B, applicable ling requirements, and
penalty information.
LINE 4. Check the appropriate box. If yes is checked, enter the name and address of the owner of the furniture or equipment.
Briey describe the nature of the business or property. Do not report household furnishings owned by tenants and used
in their living quarters, or other personal property owned or controlled by tenants.
LINE 5. Check the appropriate box. If yes is checked, enter the name and address of the owner or lessor and the quantity and
description of the furniture or equipment. The lessor of the items will be asked to declare them.
LINE 6. Enter the number of fully furnished, partly furnished, and unfurnished units in the appropriate column or columns. If the
owner of the building (other than a corporation) occupies a unit as his living quarters, do not include it. Please indicate
in the REMARKS area the items contained in a typical PARTLY FURNISHED apartment of each size. A sleeping room
is a room with no kitchen facilities; a studio contains a kitchen and a convertible living room; a 1 bedrm. contains a
bedroom, living room, kitchen, etc. Attach additional sheets if necessary.
LINE 7. Enter the cost of supplies that are on hand at 12:01 a.m. on January 1 of this year. Include janitorial and pool supplies,
whether carried in your asset accounts or expensed.
LINES 8 and 9. Enter the total cost from Schedules A and B.
SCHEDULE A. Complete the schedule as instructed. If a portion of the furniture used in your rental units has been placed in
storage, include the cost in the schedule and enter in the remarks the address where stored. Do not include
built-in appliances, installed carpeting, or drapes as furniture; such items are considered part of the building.
Include ranges, refrigerators, dishwashers, etc., if not built-in.
SCHEDULE B. Complete the schedule as instructed. Include all equipment not reported in Schedule A. If you care to attach
a schedule listing types of equipment separately, you may do so.
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 duciary,
or a person authorized to sign on behalf of the assessee. In the case of a corporation, the declaration must be signed by an
ofcer 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 certied public accountant, a public accountant, an
enrolled agent or a duly appointed duciary, the assessee’s written authorization of the employee or agent to sign the declaration
on behalf of the assessee must be led 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.
A property statement that is not signed and executed in accordance with the foregoing instructions is not validly led. The penalty
imposed by section 463 of the Revenue and Taxation Code for failure to le is applicable to unsigned property statements.
THIS STATEMENT IS NOT A PUBLIC DOCUMENT. THE INFORMATION DECLARED
WILL BE HELD SECRET BY THE ASSESSOR.