Affidavit For Exemption Of Personal Property For An Insurance Company Or Financial Corporation Form

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ASSESSOR OF FRESNO COUNTY, CALIFORNIA
For assistance, call (559) 600-3534
Affidavit for exemption of personal property for an
taxed
Insurance Company
under the provisions of Section 28 of Article XIII of the California Constitution.
or
Affidavit for exemption of personal property for a
taxed
Financial Corporation
under the provisions of Section 23186 of the Revenue and Taxation Code.
To receive full exemption from property tax assessment of personal property,
file this affidavit with the Assessor by April 1.
FIXTURE ITEMS ARE CONSIDERED REAL PROPERTY, THEY ARE TAXABLE,
AND THEY MUST BE DECLARED ON THE ALTERNATE SCHEDULE A.
Name
Street
City
State & Zip Code
1.
___________________________________________________________________________________________________ states:
(Name of Affiant)
2.
That as ___________________________________________________________________________________________________
(Title)
3.
Of the ___________________________________________________________________________________________________
(Corporate Name)
that the above-named corporation is an Insurance Company and is subject to the tax rates specified by
Section 28 of Article XIII of the California Constitution is therefore exempt from personal property taxation.
or
that the above-named corporation is a Financial Corporation and is subject to the tax rates specified by
Section 23186 of the Revenue and Taxation Code and is therefore exempt from personal property taxation
as provided by Section 23182 of the Revenue and Taxation Code.
4.
The Corporation Number issued by the California:
Department of Insurance for the above-named Insurance Company is: NAIC
Secretary of State for the above-named Financial Corporation is:
 Yes
5.
Indicate whether additional information is attached to this affidavit.
No
6.
Person to contact during normal business hours for additional information:
Name
_______________________________________________________________________________
Address
_____________________________________________________________________________
Telephone
(_______)
________________________________________________________________
I declare under penalty of perjury that the foregoing affidavit and any accompanying schedules and
statements is true, correct, and complete to the best of my knowledge and belief.
( ______ ) __________________ __________________________________________ ___________________
Telephone number
Signature of authorized person making claim
Date
FCA 3027 (Revised 12/2007)

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