Assessor P.O. Box 12004 Riverside, CA 92502-2204 (951) 955-6200 LARRY W. WARD COUNTY OF RIVERSIDE ASSESSOR-COUNTY CLERK-RECORDER www.riversideacr.com REQUEST FOR ASSESSOR INFORMATION Assessor Use Only OCR #: _______________________ Section #: _______________________ Rec’d By: _______ Date: __________ Proc’d By: _______ Date: __________ Mail By: _______ Date: __________ Please complete the following sections: Requestor Information Section I. I am the legal owner of the property for which I am requesting information. Yes No Requestor Name: _____________________________________________________________________________ Business Name: _____________________________________________________________________________ Mailing Address: _____________________________________________________________________________ Street Daytime Phone: City State _________________________ Zip Other Phone: ______________________ Order Information. Section II. Please indicate the number of each product requested and enter the total cost. Order Code Product Assessor’s Map Copy Certified Map Copy Certified Microfiche Copy (per page) Property Characteristics Report (1 to 10 assessment numbers) Other __________________________ Number Requested Unit Cost Extended Cost A B C D ________ ________ ________ ________ 3.00 ea. 3.00 ea. 1.00 ea. 10.00 ea. $_______ $_______ $_______ $_______ E ________ _________ $_______ Total $_______ Indicate Order Code(s) and Assessment Number(s) in the spaces below: Order Code Assessment Number Order Code Assessment Number Section III. In accordance with Section 408.3(d) of the Revenue and Taxation Code, the Assessor is not liable for erroneous or incomplete data. Section IV. I certify that the information provided by me is true and complete to the best of my knowledge. Requestor’s Signature: _____________________________________ Date: ______________________________ Note: Form must be signed by the Requestor for the Assessor to process this request. ACR 402P-AS4PSO (Rev. 10/2006) Available in Alternate Formats American LegalNet, Inc. www.FormsWorkflow.com