(ADDRESS (street city state zip code))
(AMOUNT $)
(BASE RENT (enter dollar amount and check one) $)
(CLEAR) CLEAR
(COMMENTS)
(CONTACT NAME)
(COUNTY)
(DATE)
(EMAIL ADDRESS)
(FAX NUMBER)
(IMPROVEMENT COST $)
(IMPROVEMENT DESCRIPTION)
(INSURANCE $)
(MAINTENANCE $)
(MANAGEMENT $)
(OTHER $)
(PRINT) PRINT
(PROPERTY ADDRESS (street city state zip code))
(REPORTING AGENCY)
(TELEPHONE NUMBER)
(UTILITIES $)
A AGENCY INFORMATION
ADDRESS (street city state zip code)
ANNUAL OPERATINg ExPENSES TO LANDLORD (enter amounts below)
Annually
ARE ThE ImPROvEmENTS OwNED By ThE TENANT?
B POSSESSORY INTEREST PROPERTY INFORMATION
BASE RENT (enter dollar amount and check one)
BOE 551 PI (12 11) STATE OF CALIFORNIA
COmmENTS
CONTACT NAmE
COUNTy
DATE AmOUNT
EmAIL ADDRESS
FAx NUmBER
Fax: (916) 274 0132
If you have any questions please contact the
ImPROvEmENT COST
ImPROvEmENT DESCRIPTION
ImPROvEmENTS TO REvERT BACk TO ThE LANDLORD AT ThE END OF ThE LEASE
Landlord
mANAgEmENT INSURANCE mAINTENANCE
monthly Semiannually
PAID By
Please return the completed form to:
PO Box 942879
POSSESSORY INTEREST LEASE REPORT BOARD OF EQUALIZATION
PROPERTy ADDRESS (street city state zip code)
RENT INCREASES
REPORTABLE INTEREST
REPORTINg AgENCy
Sacramento CA 94279 0061
State Assessed Properties Division
State Assessed Properties Division at:
State Board of Equalization
Telephone (916) 274 3270
TELEPhONE NUmBER
Tenant
Use one form per tenant (State Assessee) Please provide a copy of any new lease agreement/amendment
UTILITIES OThER
yes No
