Form BOE-267-H-A, Elderly or Handicapped Families Family Household Income Reporting Worksheet – Los Angeles County, CA

Form BOE-267-H-A, Elderly or Handicapped Families Family Household Income Reporting Worksheet, is the statement in which an occupant of housing for elderly or handicapped families reports household size and confirms that prior-year family household income did not exceed the limit for that size.

The worksheet rests on Section 214(f) of the Revenue and Taxation Code. As the form explains, property owned by nonprofit organizations that provide housing for low- and moderate-income elderly or handicapped families can qualify for the welfare exemption from property taxes for those units whose family household income does not exceed the limits printed on the form.

The form has a table of income limits for family households of 1 to 8 persons, a question about whether people sharing a unit consider themselves a family, line 1 for the number of persons in the family household, and line 2 for the income limit that applies to that number. It ends with a certification under penalty of the laws of the State of California, with name, title, date and signature.

The occupant does not file this worksheet with the Assessor. It goes to the manager of the organization, who uses it to complete the form that must be filed with the Assessor and who keeps it for the organization's records. The Assessor's forms page also lists BOE-267-H, Welfare Exemption Supplemental Affidavit Housing Elderly or Handicapped Families, which is a separate form.

Occupants of units in housing that a nonprofit organization provides for low- and moderate-income elderly or handicapped families complete this worksheet when the manager of the organization asks for it. The housing organization needs the information to support the welfare exemption for those units.

Conditions printed on the form:

• If more than one person lives in a unit, the form asks whether the occupants consider themselves a family.
• If the answer is No, report on line 1 the number of persons in your own family. Each non-family member must complete a separate statement.
• Addresses must be a street address or unit number; the form does not accept P.O. box numbers.

The manager of the organization receives the signed worksheets and retains them. The form does not say who may sign for an occupant, so it provides only for the name, title, date and signature of the person certifying.

Complete, sign and return the worksheet promptly after the manager of the housing organization gives it to you. The form asks for speed so the organization has time to complete the form that must be filed with the Assessor. No calendar due date is printed on the worksheet itself.

The income you certify is for the prior calendar year: line 2 states that the family household income for that year did not exceed the limit that matches your family household size. Have that figure and your household count ready before you start.

The worksheet has one channel: return the signed form to the manager of the organization that provides your housing.

• Return to the manager. The form tells you to complete, sign and return the statement to the manager. It prints no mailing address, portal or appointment rule for the Assessor.
• What the manager does. The manager uses the worksheet to complete the form that must be filed with the Assessor and retains your worksheet for the organization's records.
• Where to find the Assessor's forms. The Los Angeles County Office of the Assessor lists its forms at https://assessor.lacounty.gov/forms.

Each non-family member living in a shared unit must complete a separate statement and return it the same way. FillingPDF lets you fill out and download the PDF; submission follows the channel above.