Claim Form For New Construction Exclusion From Supplemental Assessment Page 2
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It is imperative that the Assessor’s Parcel Number(s) [APN] for either the parent parcel or for all
parcels for which you are claiming the exclusion be provided. If the APN(s) are not available at
the time of filing, you must provide the assessor the parcel numbers immediately upon filing for
your permit and prior to beginning construction via phone or fax, (951) 413-2800 or (951) 413-
2831, respectively. Failure to provide the assessor with all requested information may result in a
denial of your exclusion claim.
ASSESSOR’S PARCEL NUMBER
LOT
UNIT
TRACT
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If additional space is needed, please attach a separate page.
STATEMENTS:
1.
I am the owner of the property described above. I will commence construction on this property on
_____________________(start date).
2.
I currently offer, or intend to offer, the property for sale or other change in ownership and do not
intend to rent, lease, occupy, or otherwise use the property, except as model home(s) or other use
as is incidental to an offer for a change of ownership.
3.
I request exclusion from supplemental assessment of the new construction that is to be erected on
the real property described herein, in accordance with the provisions of Section 75.12 of the
California Revenue and Taxation Code.
4.
I understand that the construction exclusion shall apply only to the supplemental assessment
regarding new construction on this property and shall not preclude the reassessment of any such
property on the Assessment Roll for succeeding January 1 lien dates or apply to any other
supplemental assessments on this property which may occur at a later time.
5.
I understand that should the real property on which the exclusion is allowed undergo a partial or
complete change of ownership during the course of the new construction, the value of the
transferred newly constructed real property would be subject to a supplemental assessment. If the
transferee of that real property desires and qualifies for an exclusion from supplemental assessment
for new construction subsequent to the transfer, a separate application must be filed prior to the
commencement of the additional new construction.
OWNERSHIP INFORMATION - Only the owner or a co-owner of the claimed property or legal
representative may sign. If you are buying this property under an unrecorded contract of sale, you
must attach a copy to this claim. If you have owned this property for less than one year, it is
strongly suggested that you attach a copy of your deed(s).
I certify (or declare) under penalty of perjury, under the laws of the State of California, that
the foregoing is true and correct.
Executed at_________________ this _______ day of ________________, year_________
Signature:_____________________________ Telephone #(_____)___________________
Print Name of Contact Person_________________________________________________
Assessment Number:
Owner?:
Acquisition Month and Year:
ACR 740 (REV 04/2012)
Available in Alternate Formats
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