BOE-517-EXT REV. 9 (12-07)
REQUEST FOR EXTENSION OF TIME TO FILE PROPERTY STATEMENT
ASSESSEE'S NAME SBE NO.
STATE OF CALIFORNIA
BOARD OF EQUALIZATION
LIEN DATE (year)
ASSESSEE'S ADDRESS (street, city, state, and zip code)
CONTACT PERSON'S NAME
CONTACT PERSON'S E-MAIL ADDRESS
CONTACT'S DAYTIME TELEPHONE NO.
( First Request for Extension Second Request for Extension
EXTENSION DATE REQUESTED
) FOR BOARD USE ONLY
APPROVED (yes/no) EXTENSION DATE GRANTED
PROPERTY STATEMENT PARTS
Tangible Property List Summary Control Statement of Land Changes Financial Schedules Schedules of Leased Equipment Studies and other voluntary information (specify) Other requested information (describe below)
Reason for extension request (R & T Code section 830.1 requires a showing of good cause):
An extension is not automatically granted. You will be notified by mail whether the extension is granted or denied. If granted, the notice will state the date to which the extension has been granted. FAXED REQUEST to fax number: 916-324-2787 (If request is faxed, it must be followed by a hard copy through regular mail.) CERTIFICATION
I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing and all information herein, including accompanying statements or documents, is true and correct and complete to the best of my knowledge and belief. If the owner is a corporation, this document must be signed by an officer of the corporation.
APPLICANT'S SIGNATURE DATE
SIGNATORY'S PRINTED NAME TITLE
FOR BOARD USE ONLY
APPROVAL OR DISAPPROVAL BY BOE STATE-ASSESSED PROPERTIES DIVISION CHIEF
Approved as noted
Disapproved
DATE
STATE-ASSESSED PROPERTIES DIVISION CHIEF'S SIGNATURE
Comments:
FOR OFFICIAL USE ONLY
CLEAR
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