Laserfiche WebLink
File No. <br />Clerk's Use Only <br />CLERK, BOARD OF SUPERVISORS <br />CLAIM FOR REFUND OF TAX PAYMENTS OR <br />DISPUTE OF ASSESSED PENALTIES BEFORE THE HEARING OFFICER <br />(Revenue & Taxation Code Sec 5096, Et Seq. and Alameda County Administrative Code section 2.116.060) <br />Claims trust be filed in duplicate and returned to: Clerk, Board of Supervisor's Office <br />1221 Oak Street, Suite 536, Oakland, CA 94612 <br />NOTE. 1) Taxes must be paid prior to filing a claim for refund. Please attach a copy of your tax bill and proof of payment <br />with this form. <br />2) If filing to dispute assessed penalties for failure to file a Change of Ownership Statement, please be informed that <br />the penalties will continue to compound until the matter is resolved. It is recommended that taxes be paid prior to <br />filing. <br />3) If filing a Cancellation or Refund of Delinquent Penalty for failure to pay your taxes timely, you must contact <br />the Tax Collectors at (510) 272-6800 for the appropriate form. <br />Please type or print clearly using Blue Ink <br />Name and Mailing Address of applicant (Please print clearly) <br />Name: <br />Last First Middle Address: Street No. City/State/Zip <br />Phone No. (Work): ( ) Home: ( <br />Property Address: <br />Assessors Parcel Number:_ <br />Acct#(s): <br />Tracer/Acct #(s) of bills sought to be refunded <br />I am filing the following type of appeal (check only one): <br />Date of Trcr Payment (if applicable):, <br />❑ Parent/Child Exclusion ❑ Other Ownership Transfers ❑ Base Value Transfers ❑ Doc. Transfer Tax <br />❑ Homeowner Exemption ❑ Other Exemption ❑ Overpayment of Taxes ** ❑ Business License <br />❑ Possessory Interest (non -value) ❑ Cancellation of Penalty for Failure to File Change of Ownership Statement <br />** For overpayments based on a belief that the assessed value of the property is incorrect, you must file an Application for Changed <br />Assessment Form. Please call Assessment Appeals Section at 510-272-6352. <br />❑ I request a Refund of Taxes in accordance with this application for: <br />Fiscal Year(s) in the amount of $ <br />I (we) claim that the: ❑ Whole Assessment ❑ Partial Assessment for the year(s) as shown above is (are) void for the following <br />reason(s) (Please use the reverse side of this form to state your reason(s) and attach supportive documents.) <br />I state under penalty of perjury of the State of California that the foregoing is true and correct to the best of my knowledge and that I <br />am (CHECK ONE): 1)_the person who paid the tax; 2)_the executor of the person who paid the tax; 3)_the administrator of the person <br />who paid the tax; 4)_the guardian of the person who paid the tax 5)_the person who is disputing the assessed penalty. If the person who <br />paid the tax is a legal entity, I am an officer of that entity duly and legally authorized to execute this document on behalf of the entity and my <br />title is , executed on this date in the County of , State of <br />Print Name: <br />Signature: <br />PALegal HOHOFORM4 (Wan S. Muranishi, Alameda County Administrator Crystal Hishida Graff, Clerk of the Board <br />1221 Oak Street, Suite 536, Oakland, California, 94612, (510) 272-6347, Fax: (510)208-9660 <br />