Form BOE-267-L3, Welfare Exemption Supplemental Affidavit, Households Exceeding Low-Income Limits-Over Income Tenant Data

The Welfare Exemption Supplemental Affidavit, Households Exceeding Low-Income Limits-Over Income Tenant Data (Form BOE-267-L3) is the affidavit a claimant files with the county assessor to report units whose "over-income" tenants earn above the lower income limit but no more than 140 percent of AMI.

The affidavit applies under Revenue and Taxation Code section 214(g)(2)(A)(iii) or (iv) and section 259.15. A unit can still be treated as occupied by a lower income household when the occupants were a lower income household on the lien date when occupancy began, their household income is no more than 140 percent of area median income (AMI), adjusted for family size, and the unit remains rent-restricted.

The form has two sections. Section 1 identifies the organization and the property. Section 2 is a table with one row per unit: address or unit number, persons in the household, annual household income, the maximum allowable rent, the actual rent charged and the percentage of AMI from which the maximum rent is derived. A certification under penalty of perjury follows.

The form is marked confidential and not subject to public disclosure; the assessor must keep it confidential under section 259.15. A companion version for the 100% AMI threshold is listed separately by the Assessor as BOE-267-L4.

You must complete this affidavit if you checked the box in Section 4.A2 of BOE-267-L or BOE-267-L1, indicating that you seek exemption on a unit under Revenue and Taxation Code section 214(g)(2)(A)(iii) or (iv). Failure to file it results in denial of the exemption.

The provisions apply only to lower income rental housing that is:

• eligible for and receiving federal low-income housing tax credits (LIHTC) under Internal Revenue Code section 42, or owned by a community land trust (CLT) and leased to a lower income household; and
• owned and operated by a nonprofit organization, an eligible limited liability company, or a limited partnership with an eligible managing general partner.

A separate affidavit must be filed for each location on which you seek exemption under these provisions. List only units that were counted in Section 4.C2 of BOE-267-L or BOE-267-L1 as occupied by households above the lower income limit but not above 140% AMI. The form names no one else who may sign; the claimant signs the certification.

The affidavit must be filed with the county assessor by 5:00 p.m. on February 15 to avoid a late-filing penalty under Revenue and Taxation Code section 270. It is filed together with the claim it supplements, BOE-267 (first filing) or BOE-267-A (annual filing).

Enter the fiscal year that follows the January 1 lien date being determined. A timely claim filed in February 2018, for example, shows fiscal year "2018-2019"; an entry of "2017-2018" on a claim filed in February 2018 signals a late claim for the preceding year. The form sets no separate processing time.

File the signed affidavit with the county assessor, together with the claim for welfare exemption it supplements (BOE-267 or BOE-267-A). The form names no other channel and prints no address; for Los Angeles County, use the Office of the Assessor's forms page at https://assessor.lacounty.gov/forms to find the form and contact the office for filing details.

Before filing, check that:

• the form is received by 5:00 p.m. on February 15;
• one affidavit is filed for each property location;
• any additional sheets for the Section 2 table are attached;
• the certification is signed, dated and shows a daytime telephone and email address.

FillingPDF lets you fill out and download the PDF; submission follows the assessor's channels above.