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Form BOE-400-TA Fillable Statement of Boundary Change
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)450 N Street MIC:59 P O Box 942879 Sacramento CA 94279 0059 ACREAGE AGENCY Alphabetical list of all streets within the affected area to include beginning and ending An election authorizing this action was held on (mm/dd/yyyy) Assessor parcel number(s) of affected territory assignment (consolidated counties BOARD OF EQUALIZATION Board of Equalization will acknowledge receipt of filing to: BOE 400 TA (P1) REV 02 (10 09) BOE File No : BOE USE ONLY Certificate of Completion (LAFCo only) chk #: City Annexation (02) City Detachment (14) City Incorporation (04) CONDUCTING AUTHORITY Consolidation of TRA s (06) COUNTY county auditor and county assessor County auditor s letter of TRA County Boundary Change (16) COUNTY NUMBER Developed District Annexation (01) District Consolidation (05) District Detachment (07) District Dissolution/Removal from Board Roll (08) District Formation (09) District Name Change (11) E MAIL ADDRESS EFFECTIVE DATE Estimated Population: FAX NUMBER (include area code) Inhabited LAFCo RES Legal description ltr #: Map of limiting addresses (2 copies) Map(s) and supporting documents Number of Areas: only) Please mail to: State Board of Equalization Tax Area Services Section Redevelopment Amendment to Project (10) Redevelopment New Project (15) REQUIRED: According to section 54902 of the Government Code copies of these documents must be filed with the Res /Ord NUMBER Resolution of conducting authority School District Merger (17) School District Thompson Unified (19) School District Transfer of Territory (13) School District Unification (18) SECTION 1: TYPE OF ACTION (CHECK ONE ONLY) SECTION 2: PRINCIPAL CITY/DISTRICT(S) AFFECTED BY ACTION [ENTER DISTRICT NAME(S)] SECTION 3: AFFECTED TERRITORY SECTION 4: ELECTION SECTION 5: ENCLOSED ARE THE FOLLOWING ITEMS REQUIRED AT THE TIME OF FILING SECTION 6: CITY BOUNDARY CHANGES ONLY SHORT FORM DESIGNATION SIGNATURE OF AGENCY OFFICER STATE OF CALIFORNIA STATEMENT OF BOUNDARY CHANGE STREET street numbers TELEPHONE NUMBER (include area code) the terms and conditions as stated in the resolution This action is exempt from election THIS DOCUMENT IS SUBJECT TO PUBLIC INSPECTION TITLE Total assessed value of all property in subject territory: Undeveloped Uninhabited Vicinity maps (2 copies) Will be taxed for existing bonded indebtedness or contractual obligations as set forth by Will not be taxed for existing bonded indebtedness or contractual obligations www boe ca gov ZIP CODE