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BOE-502-A (P1) REV, 14 (05-18) PRELIMINARY CHANGE OF OWNERSHIP REPORT To be completed by the transferee (buyer) prior to a transfer of subject property, In accordance with Section 480.3 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. NAME AND MAILING ADDRESS OF BUYERITRANSFEREE (Make necessary corrections to the printed name and mailing address) City of Santa Ana, Public Works Agency 20 Civic Center Plaza , M-36 Santa Ana, CA 92702 STREET ADDRESS OR PHYSICAL LOCATION OF REAL PROPERTY ASSESSOR'S PARCEL NUMBER 016-211-25 SELLER/TRANSFEROR Salvador Arreola Valencia BUYER'S DAYTIME TELEPHONE NUMBER 714-647-5013 BUYER'S EMAIL ADDRESS ❑ YES IN NO This property is Intended as my principal residence. If YES, please Indicate the date of occupancy I MO I DAY I YEAR or intended occupancy. ❑ YES 1%NO Are you a disabled veteran or an unmarried surviving spouse of a disabled veteran who was compensated at 100% by the Department of Veterans Affairs? MAIL PROPERTY TAX INFORMATION TO (NAME) M-36 MAIL PROPERTY TAX INFORMATION TO (ADDRESS) CITY PART I: TRANSFER INFORMATION Please complete all statements. This section contains possible exclusions from reassessment for certain types of transfers. YES NO ❑ W A. ❑ IN B. ❑ X1 C. ❑ 211*D. ❑ 9-E. STATE I ZIP CODE This transfer is solely between spouses (addition or removal of a spouse, death of a spouse, divorce settlement, etc.). This transfer Is solely between domestic partners currently registered with the California Secretary of State (addition orremova/ of a partner, death of a partner, termination settlement, etc.). This is a transfer: ❑ between parent(s) and child(ren) O from grandparent(s) to grandchild(ren). This transfer is the result of a cotenant's death. Date of death This transaction is to replace a principal residence by a person 55 years of age or older. Within the same county? ❑ YES ❑ NO ❑ * F. This transaction is to replace a principal residence by a person who is severely disabled as defined by Revenue and Taxation Code section 69.5. Within the same county? ❑ YES ❑ NO ❑ IN G. This transaction is only a correction of the name(s) of the person(s) holding title to the property (e.g., a name change upon marriage). If YES, please explain: ❑ 6 H. The recorded document creates, terminates, or reconveys a lender's interest in the property. ❑ IN I. This transaction is recorded only as a requirement for financing purposes or to create, terminate, or reconvey a security interest (e.g., cosigner). If YES, please explain: ❑ IN J. The recorded document substitutes a trustee of a trust, mortgage, or other similar document. K. This is a transfer of property: ❑ 1. to/from a revocable trust that may be revoked by the transferor and is for the benefit of ❑ the transferor, and/or ❑ the transferor's spouse ❑ registered domestic partner. ❑ IN 2. loffrom an irrevocable trust for the benefit of the ❑ creator/grantor/trustor and/or ❑ grantor's/lrustor's spouse ❑ grantor's/trustor's registered domestic partner. ❑ L. This property is subject to a lease with a remaining lease term of 35 years or more including written options. ❑ 129 M. This is a transfer between parties in which proportional interests of the transferor(s) and transferee(s) in each and every parcel being transferred remain exactly the same after the transfer. ❑ N This is a transfer subject to subsidized low-income housing requirements with governmentally imposed restrictions, or restrictions imposed by specified nonprofit corporations. ❑ O. This transfer is to the first purchaser of a new building containing an active solar energy system. ❑ P. Other. This transfer is to * Please refer to the instructions for Part 1. Please provide any other information that will help the Assessor understand the nature of the transfer. THIS DOCUMENT IS NOT SUBJECT TO PUBLIC INSPECTION SFRM0017 (DSI Rev. 08/31120)