Form Exm-202 - Authorization Of Tax Agent Or Agency Substitution Form For Assessment, Property Tax Or Appeals Matter Page 2
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2AUTHORIZATION OF TAX AGENT OR AGENCY SUBSTITUTION
Owner / Principal’s Name
Property Address
Assessment Appeals Board
Office of the Assessor
Auditor-Controller
Treasurer and Tax Collector
500 W. Temple Street, Rm. B4
500 W. Temple Street, Rm. 225
500 W. Temple Street, Rm. 153
225 N. Hill Street, 1st. Floor
Los Angeles, California 90012-2770
Los Angeles, California 90012-2770
Los Angeles, California 90012-2770
Los Angeles, California 90012-2770
(213) 974-1471
(213) 974-3211
(213) 974-8368
(213) 974-2111
I.
This authorizes (please print)
Agent’s Name
Tax Agent Registration #
Business Address
Telephone No. (
)
Email Address
to act as an agent in assessment, appeals, and/or other tax matters for those properties owned or controlled by the undersigned
according to the authority indicated (please mark appropriate boxes).
Mark this box when substituting this (new) agent for another previously authorized.
Mark this box if the Agent is not an individual who is employed, under contract, or otherwise receiving compensation
to communicate directly, or through agents, employees or subcontractors, with any County official for the purpose of
influencing official action -OR- if the Agent is a person representing himself, herself, an immediate family member or
an entity of which the person is a partner, officer, or owner of ten percent or more of the value of the entity.
Secured Assessor’s Identification Number: Mapbook
Page
Parcel
If more than one parcel is covered by this authorization please attach a list of all parcels by Assessor’s Identification Number. List
personal property by address.
II.
Office of the Assessor
Office of the Auditor-Controller
Office of the Treasurer and Tax Collector
Agent has full authority to handle all assessment matters with your office. Agent shall have access to all information and
materials that would be available to principal.
Agent may sign Property Statements as provided under California Revenue and Taxation Code, §441.
This authorization is valid for a period of four years from the date of execution, unless earlier revoked in writing or terminated by
operation of law.
This authorization is valid until (date)
Additional instructions
III. Assessment Appeals Board
Agent has full authority to act in connection with the filed principal’s application for equalization, (copy must be attached)
including withdrawal of such application, the ability to enter into a stipulated agreement as to value, and settlement of all related
legal issues for the parcels and tax years indicated on the application. This authorization will end at the time your assessment
appeals application is withdrawn or reaches its conclusion through the assessment appeal process
Application Number
IV. Principal accepts full responsibility for any action of the agent carried out pursuant to the authority granted herein
CERTIFICATION
I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing and all information hereon, including any
.
accompanying statements or documents, is true, correct and complete to the best of my knowledge and belief
Owner/Principal’s Name (Print)
Telephone No. (
)
Email Address
Executed in ________________________________,_______ this ____________ day of________ , 20_________.
(city)
(state)
SIGNATURE OF PROPERTY OWNER OR AUTHORIZED PRINCIPAL OR OFFICER
TITLE
V.
If only items in Part II are marked, please send this form to the Office of the Assessor, the Auditor-Controller, and/or the Treasurer
and Tax Collector, as appropriate. If all boxes were selected, please send the form to the Office of the Assessor
VI. If only Part III is marked, please send this form to the Assessment Appeals Board but only if you have already filed an appeal
(attach copy).
VII. If II & III are marked, please send this form to the Assessment Appeals Board and a copy to the Office of the Assessor.
VIII. To effectively revoke this authorization, notify the Assessor or the Assessment Appeals Board and your agent, in writing.
IX. Effective July 1, 2013 this form is not valid without a current Tax Agent Registration Number unless one of the exclusions exist
under Los Angeles County Code Section 2.165.010 (G).
Approval (County Use Only)
EXM-202 (BACK) (REV. 5-13)
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