Assessor P.O. Box 12004 Riverside, CA 92502-2204 (951) 955-6200 LARRY W. WARD ASSESSOR-COUNTY CLERK-RECORDER COUNTY OF RIVERSIDE www.riversideacr.com Application for Reassessment (Property Damaged by Misfortune or Calamity) Name _________________________________________ Parcel Number: __________________ Mail Address ___________________________________________________________________ Location of Damaged Property _____________________________________________________ Telephone Number _____________________ Was the real property damaged? Was any personal property damaged? or completely destroyed? None or completely destroyed? None Date of Calamity ______________________________ Your opinion of value of the real property before the calamity: $__________________________ Your opinion of value of the personal property before the calamity: $_______________________ Please rate its condition before the calamity (check one): Excellent Good Average Fair Poor Your opinion of the value of the property after the calamity: $ ____________________________ Contractor's estimate to restore or replace lost or damaged property $ _____________________ Describe its condition after the calamity (continue on the back if necessary): ________________ _____________________________________________________________________________ _____________________________________________________________________________ (All of the questions above must be answered before the application can be accepted.) I hereby apply for reassessment of the property described above, under the terms of Riverside County Ordinance 538. I declare under penalty of perjury that the property in question was damaged or destroyed at no fault of my own. If the property is damaged, I declare that I am the owner of the property, or have it in my possession and control, or that I am responsible for the taxes on it. Signature__________________________________________ Date _____________________ If executed outside the State of California, this application must be signed before a notary. Notary Stamp: Name (Please Print) Address ACR 702P-AS3AD0 (Rev. 11/2006) Available in Alternate Formats American LegalNet, Inc. www.FormsWorkflow.com