Assessor Mailing Address

PETER ALDANA (951) 955-6200 P.O. Box 751

COUNTY OF RIVERSIDE Riverside, CA 92502-0751
County Clerk-Recorder
ASSESSOR-COUNTY CLERK-RECORDER (951) 486-7000 www.riversideacr.com
www.riversidetaxinfo.com

AFFIDAVIT OF OWNERSHIP TRANSFER

(Attach additional sheets if necessary)

Document Number: _________________________ Recording Date: _________________

1. ______________________________________________________, Grantor (transferor) is a:

A. Corporation Partnership Individual LLC
B. If grantor is a corporation, partnership, or LLC, list the individual owners and their
Percentage (%) of ownership.

Owners Name % Owned

1.) ______________________________________ __________________
2.) ______________________________________ __________________
3.) ______________________________________ __________________
4.) ______________________________________ __________________

2. ______________________________________________________, Grantee (transferee) is a:

A. Corporation Partnership Individual LLC

B. If grantee is a corporation, partnership, or LLC, list the individual owners and their
Percentage (%) of ownership.
Owners Name % Owned
1.) ______________________________________ __________________
2.) ______________________________________ __________________
3.) ______________________________________ __________________
4.) ______________________________________ __________________

I certify (or declare) under penalty of perjury, under the laws of California, that the foregoing
and all information hereon, including any accompanying statements or documents, is true,
correct and complete to the best of my knowledge and belief.

______________________________________________________________________________
Full Legal Name if Incorporated

______________________________________________________________________________
Signature of Owner, Partner, Officer or Authorized Agent

__________________________________ ________________ ______________________

Title Date Telephone Number

ACR 919 (Rev. 04/2008) Available in Alternate Formats