COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. APPLICATION FOR REASSESSMENT : Calendar No. PROPERTY DAMAGED OR DESTROYED BY MISFORTUNE OR CALAMITY COUNTY OF LOS ANGELES, RICK AUERBACH, ASSESSOR : 500 W. TEMPLE STREET, LOS ANGELES, CA 90012-2770 JUDICIAL Plaintiff(s) SUBPOENA -against: THIS APPLICATION MUST BE FILED WITHIN 60 DAYS OF THIS DATE OF NOTIFICATION MONTH DATE YEAR : In accordance with Section 170 of the Revenue and Taxation Code of the State of California, I hereby apply for a reassessment of the following described property which was damaged or destroyed through no fault of my own. : THE DAMAGE WAS AT LEAST $10,000. Address of Damaged Property . .............. Defendant(s) : ....................................... CITY Type of Damaged Property: Real Property Business Personal Property THE PEOPLE OF THE STATE OF NEW Inventory YORK Boat or Aircraft TO If available from Tax Bill please indicate: Secured Tax Bill Map Book Page Unsecured Tax Bill Unsecured Tax Bill Assm't No. Boat or Aircraft Registration No. Personal Property Parcel Fixtures Tax Rate Area Index No. Bill No. GREETINGS: 1. Date the damage occurred: Date repaired: WE COMMAND YOU, that 2. Type of property damaged or destroyed consisted of: all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court 3. Damage was caused by: located at County of 4. Describe the damage: in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the 5. The amount of damage to Real Property $ DATE OF FILING: Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. The amount of damage towhose behalf this subpoena was the party on taxable Personal Property $ (Do not include household furnishings or personal effects.) 6. If you acquire repair bills or estimates, please attach copies. Witness, Honorable Court in County, , one of the Justices of the (This request does not extend the 60-day filing requirement.) day of , 20 Attorney(s) for I declare under penalty of perjury that all of the foregoing statements are, to the best of my knowledge, true and correct. Applicant's Name (please print) Phone (from 8:00 a.m. to 5:00 p.m.) Applicant's Signature City Office and P.O. Address Zip Code Date 76A636C ADS-820 (REV. 5/02) PARCEL Telephone No.: Facsimile No.: E-Mail USE REVERSE SIDE FOR REMARKS AND ADDITIONAL INFORMATION Address: Mobile Tel. No.: MAIL TO ABOVE ADDRESS! ATTENTION: MCU ROOM 286 PAGE Applicant's Mailing Address MAP BOOK If my property is reassessed, and taxes have been paid, this application shall constitute a claim for refund. T.R.A. We strongly recommend that photographs of the damaged property be taken. If copies of the photographs are (Attorney must sign above and type name enclosed with the application for reassessment, the Assessor's Department will be able to process your below) application more quickly. ASSESSOR'S USE ONLY If you acquire repair bills or estimates after filing this application, mail copies to the above address. Attention: MCU Room 286 American LegalNet, Inc. www.USCourtForms.com