PETER ALDANA COUNTY OF RIVERSIDE ASSESSOR-COUNTY CLERK-RECORDER County Clerk-Recorder P.O. Box 751 Riverside, CA 92502-0751 (951) 486-7000 www.riversideacr.com RECORDER'S OFFICE CLAIM FOR REFUND ON OVERPAYMENT OF REAL PROPERTY TRANSFER TAX The undersigned certifies that payment of Real Property Transfer Tax in the amount of made to the County of Riverside. $ has been Type of document (Copy must accompany claim) Document Number Recording Date Under Revenue and Taxation Code, Sec. 11934, a refund of 1. Full Value of Property Less Liens + Encumbrances Net Taxable $ 2. Tax Affixed is requested. $ $ $ $ $ ($50.00) $ Correct Tax less $ 50.00 fee to be refunded 3. Explanation: Sections 1, 2 and 3 must be completed or refund request will be denied. I hereby certify, under penalty of perjury, that facts herein contained are true and correct. No previous claim for refund has been submitted. Date: Signature of claimant: Must represent original payer Name: Address: City, State, Zip Code FOR RECORDER DEPT. USE ONLY It is recommended that this request be: Approved: Denied: By: RIVERSIDE COUNTY RECORDER Date: ACR 196 ( Rev. 02/2007) Available in Alternate Formats American LegalNet, Inc. www.FormsWorkFlow.com