INSTRUCTIONS

Before you begin you should have all property information in front of you.

If you feel you are entitled to a refund of taxes and/or penalties paid under Revenue and Taxation Code Section 5096, et seq, you are required to complete this form and file it with the Clerk of the Board of Supervisors. You MUST pay your taxes or penalty prior to filing this claim. Once you have completed this form, mail or personally deliver it and all relavant evidence to:

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Signature

All claims must be signed by the claimant or claimant's agent. Signatures should be in blue ink to easily identify original claims.
If you have any questions, contact the Clerk of the Board at ...

To Print Claim, you must have Adobe Acrobat Reader 6 or higher installed on your PC. You can download a free Adobe PDF Reader at Adobe's Web site.