Claim For Refund
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Claim For Refund Form. This is a California form and can be use in Riverside Local County.
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Tags: Claim For Refund, ACR 197P, California Local County, Riverside
LARRY W. WARD
COUNTY OF RIVERSIDE
ASSESSOR-COUNTY CLERK-RECORDER
County Clerk-Recorder
P.O. Box 751
Riverside, CA 92502-0751
(951) 486-7000
CLAIM FOR REFUND
The undersigned declares that payment in the amount of
Riverside for the following:
$
has been made to the County of
Type of document
Receipt number
A refund in the amount of
Date
$
Doc. # if applicable
is requested.
EXPLANATION:
I hereby certify, under penalty of perjury, that the facts stated above are true and correct.
No previous claim for refund has been submitted.
NAME OF CLAIMANT:
SIGNATURE
ADDRESS
CITY, STATE, ZIP CODE
PHONE #
DATE:
FOR RECORDER DEPT. USE ONLY
IT IS RECOMMENDED THAT THIS REQUEST BE:
APPROVED:
ACR 197P-AS2AC0 (Rev. 02/2007)
DENIED:
RIVERSIDE COUNTY CLERK-RECORDER
BY:
DATE:
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