Change In Ownership Statement Death Of Real Property Owner Form - Santa Cruz County Assessor
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1County of Santa Cruz
GARY E. HAZELTON, ASSESSOR
Jessie Mudgett
701 OCEAN ST., Rm. 130, SANTA CRUZ, CA 95060
Chief Deputy-Administration
(831) 454-2002 FAX: (831) 454-2495
Sean Saldavia
Chief Deputy-Valuation
Change in Ownership Statement
Death of Real Property Owner
Important Notice
Section 480(b) of the Revenue and Taxation Code requires that the personal representative file this statement with the Assessor in
each county where the decedent owned property at the time of death. File a separate statement for each parcel of real property owned
by the decedent in Santa Cruz County.
This notice is a written request from the Office of the Assessor for a Change in Ownership Statement. Failure to file this statement
results in the assessment of a penalty. This statement will be held secret as required by Section 481 of the Revenue and Taxation
Code.
Filing this form does not change title to the property. Title can only be changed by recording an appropriate document with the County Recorder.
The property may be subject to a supplemental assessment in an amount to be determined by the Santa Cruz County
Assessor. For further information on your supplemental roll obligation, please call the Appraisal Division at (831) 454-2002.
1.
Estate of: ________________________________ , deceased.
2.
Probate No.: _______________
3.
Date of Death: _____________________________________________
4.
Address of Real Property: __________________________________________________________________
Assessor’s Parcel Number(s): _________________________
Heirs/Devisees of Subject Property and Relationship to the Decedent
5.
:
Percentage of Property
Name
Relationship
Each Will Receive
___________________________________
____________________________________
_________________________
___________________________________
____________________________________
_________________________
___________________________________
____________________________________
_________________________
___________________________________
____________________________________
_________________________
___________________________________
____________________________________
_________________________
6.
If any additional property taxes are due, they will be billed to the Heirs/Devisees at:
Name:
____________________________________________________
Address:
___________________________________________________________________________
Is this property to be sold out of the estate? Yes
No
7.
The Office of the Assessor may contact you for additional information regarding this transaction.
I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing and all information hereon,
including any accompanying statements or documents, is true, correct and complete to the best of my knowledge and belief.
____________________________________________
___________________________________________
Please Print Name
Signature of:
Executor/Administrator
Attorney
_____________________
__________________________________
Date
Telephone Number where you are available from 8am to 5pm
EXCELLENCE – INTEGRITY - SERVICE
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