Claim For Refunds - Create New Claim

(Revenue & Taxation Code Sec 5096, et seq)

Section 1 - Claimant Details

Applicant Type *

First Name *

Last Name *

Company Name *

Agent Name

Address 1 *

Address 2

Address 3

Address 4

City *

Country

State *

Zip Code *

Primary Phone *

(US)

Ext.

Alternate Phone - 1

(US)

Ext.

I certify under pernalty of perjury that the forgoing is true and correct. Executed at * , this date * by *

I wish to apply for a refund of *

Overpayment Of Taxes Paid (T) Penalties For Late Payment (P)

Section 2 - Refund for Overpayment of Taxes Paid

Select one *

I disagree with the decision of the Assessment Appeals Board. Enter the Application's in Property Information Section

I overpaid my taxes on the below referenced property

Refund type *

Partial Full

Taxes were Incorrectly collected for the following reasons. *

Section 3 - Refund of Penalties for Late Payment of Taxes Paid

Penalty was applied in error on the below referenced property/bill.

Penalty were Incorrectly collected for the following reasons. *

Section 4 - Property Details

Please complete all applicable property details.

Appeal No.	APN	Assessment No.	Amount($)	Tax Year

Backup Documentation Is Provided

Total Claim Amount($) 0

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