Form BOE-516 Fillable Wireless Communication Sites

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(Check box if yes) (CLEAR) CLEAR (Column A SBE MAP NO (if applicable)) (Column A SBE MAP NO (if applicable)) (Column A SBE MAP NO (if applicable)) (Column A SBE MAP NO (if applicable)) (Column A SBE MAP NO (if applicable)) (Column A SBE MAP NO (if applicable)) (Column A SBE MAP NO (if applicable)) (Column A SBE MAP NO (if applicable)) (Column A SBE MAP NO (if applicable)) (Column B DATE OF LEASE) (Column B DATE OF LEASE) (Column B DATE OF LEASE) (Column B DATE OF LEASE) (Column B DATE OF LEASE) (Column B DATE OF LEASE) (Column B DATE OF LEASE) (Column B DATE OF LEASE) (Column B DATE OF LEASE) (Column C ASSESSOR'S PARCEL NO (APN)) (Column C ASSESSOR'S PARCEL NO (APN)) (Column C ASSESSOR'S PARCEL NO (APN)) (Column C ASSESSOR'S PARCEL NO (APN)) (Column C ASSESSOR'S PARCEL NO (APN)) (Column C ASSESSOR'S PARCEL NO (APN)) (Column C ASSESSOR'S PARCEL NO (APN)) (Column C ASSESSOR'S PARCEL NO (APN)) (Column C ASSESSOR'S PARCEL NO (APN)) (Column D STREET ADDRESS CITY) (Column D STREET ADDRESS CITY) (Column D STREET ADDRESS CITY) (Column D STREET ADDRESS CITY) (Column D STREET ADDRESS CITY) (Column D STREET ADDRESS CITY) (Column D STREET ADDRESS CITY) (Column D STREET ADDRESS CITY) (Column D STREET ADDRESS CITY) (Column E LESSOR) (Column E LESSOR) (Column E LESSOR) (Column E LESSOR) (Column E LESSOR) (Column E LESSOR) (Column E LESSOR) (Column E LESSOR) (Column E LESSOR) (Column F LEASE TERM) (Column F LEASE TERM) (Column F LEASE TERM) (Column F LEASE TERM) (Column F LEASE TERM) (Column F LEASE TERM) (Column F LEASE TERM) (Column F LEASE TERM) (Column F LEASE TERM) (Column G Land Owner1 Footnote 1 Enter owner name only ) (Column G Land Owner1 Footnote 1 Enter owner name only ) (Column G Land Owner1 Footnote 1 Enter owner name only ) (Column G Land Owner1 Footnote 1 Enter owner name only ) (Column G Land Owner1 Footnote 1 Enter owner name only ) (Column G Land Owner1 Footnote 1 Enter owner name only ) (Column G Land Owner1 Footnote 1 Enter owner name only ) (Column G Land Owner1 Footnote 1 Enter owner name only ) (Column G Land Owner1 Footnote 1 Enter owner name only ) (COMPANY NAME) (COUNTY NAME) (County No ) (if applicable) (LIEN DATE (year)) (PRINT) PRINT (ROW 1 ITEM NO ) (ROW 10 ITEM NO ) (ROW 11 ITEM NO ) (ROW 12 ITEM NO ) (ROW 13 ITEM NO ) (ROW 14 ITEM NO ) (ROW 15 ITEM NO ) (ROW 16 ITEM NO ) (ROW 17 ITEM NO ) (ROW 2 ITEM NO ) (ROW 3 ITEM NO ) (ROW 4 ITEM NO ) (ROW 5 ITEM NO ) (ROW 6 ITEM NO ) (ROW 7 ITEM NO ) (ROW 8 ITEM NO ) (ROW 9 ITEM NO ) (SBE NO ) (Sticky Note comment SBE NO 1 Alameda 16 Kings 31 Placer 46 Sierra 10 Fresno 25 Modoc 40 San Luis Obispo 55 Tuolumne 11 Glenn 26 Mono 41 San Mateo 56 Ventura 12 Humboldt 27 Monterey 42 Santa Barbara 57 Yolo 13 Imperial 28 Napa 43 Santa Clara 58 Yuba 14 Inyo 29 Nevada 44 Santa Cruz 15 Kern 30 Orange 45 Shasta 1Enter owner name only 2 Alpine 17 Lake 32 Plumas 47 Siskiyou 3 Amador 18 Lassen 33 Riverside 48 Solano 4 Butte 19 Los Angeles 34 Sacramento 49 Sonoma 5 Calaveras 20 Madera 34 San Benito 50 Stanislaus 6 Colusa 21 Marin 36 San Bernardino 51 Sutter 7 Contra Costa 22 Mariposa 37 San Diego 52 Tehama 8 Del Norte 23 Mendocino 38 San Francisco 53 Trinity 9 El Dorado 24 Merced 39 San Joaquin 54 Tulare 9/25/2012 1:27:58 PM ASSESSEE ASSESSOR S BOARD OF EQUALIZATION BOE 516 (BACK) REV 10 (12 12) BOE 516 (FRONT) REV 10 (12 12) BY STATE Column A Enter the SBE map number if the land is subject to state assessment Column B Enter the date of the lease inception Column C Enter the Assessor s Parcel Number (APN) of the property upon which the site is located if available column D and return this form with your property statement filing Column D Enter the street address and city of the site Either column C or column D must be completed for each site Column E Enter the name of the lessor Column F Enter the lease term including option year(s) Column G Enter the name of the land owner Column H Check the corresponding box if tower is owned by state assessee COMPANY NAME COUNTY COUNTY COUNTY COUNTY COUNTY NAME COUNTY NO DATE OF FOR OFFICIAL If you have questions regarding this form or need instructions on filing electronically please contact the State Assessed Properties Division Wireless Communications lead person INSTRUCTIONS LAND OWNER1 LEASE LEASE TERM LESSOR LIEN DATE (year) PARCEL NO (APN) Please enter your four digit SBE Number here If you do not know your SBE Number or wish to verify it refer to the State Assessed Property Program State Assessee SBE Number Listing that is located on this web site ) Please read instructions on reverse before preparing this schedule Report all sites whether subject to local or state assessment jurisdiction acquired during Calendar Year 2012 Report all sites whether subject to local or state assessment jurisdiction acquired during Calendar Year 2012 If there were no sites acquired during the year enter none in SBE MAP NO SBE NO STATE OF CALIFORNIA STREET ADDRESS CITY TOWER OWNER USE ONLY WIRELESS COMMUNICATION SITES

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