Application For Tax Segregation Form - Santa Cruz County, California
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1
2APPLICATION FOR TAX SEGREGATION
SEAN SALDAVIA, SANTA CRUZ COUNTY ASSESSOR-RECORDER
701 OCEAN ST., RM. 130, SANTA CRUZ CA 95060; PHONE 831-454-2002
A $36.00 per parcel processing fee must be included at the time the application is submitted.
Under the provisions of Section(s) 2801-2827 of the Revenue and Taxation Code, the undersigned hereby makes application for the
segregation of the following property for the current tax. To avoid penalties, this application, with the required statements and/or
certifications must be filed with this office prior to December 1 (April 1 for second installment).
1. Date___________________
2. Parcel No.________________________
3. Tax Code Area_________________________
4. Assessee
___________________________________
Mailing Address___________________________________
Property Address _____________________________________
___________________________________
_____________________________________
5. I, _________________________, hereby certify under penalty of perjury that the property referred to in Item 2 above is evidenced
by a duly executed Document No._______________which is recorded in the Official Records of the County of Santa Cruz, CA on
Recording Date_________________. That said property is not covered by a new subdivision map filed subsequent to 12:01 a.m.
on the first day of January preceding the current fiscal year.
6. Applicant _______________________________________
Mailing Address__________________________________
Business Phone __________________________________
__________________________________
Residence Phone__________________________________
7. Applicant’s Signature_______________________________
8. Processing Fee $________________________________
OFFICE USE ONLY
By Tax Collector:__________________________ Date:________________
Values: Real Estate*______________ Improvements______________Personal Prop______________ Exemption_______________
*See attached for Special Assessments.
New Parcel(s) Description
By Assessor:
__________________________ Date:________________
Parcel No./Tax Rate Area
__________________________________
Real Estate _______________________________
Assessee
__________________________________
Improvements_____________________________
Situs Address
__________________________________
Exemption________________________________
__________________________________
Personal Prop_____________________________
Parcel No./Tax Rate Area
__________________________________
Real Estate _______________________________
Assessee
__________________________________
Improvements_____________________________
Situs Address
__________________________________
Exemption________________________________
__________________________________
Personal Prop_____________________________
Parcel No./Tax Rate Area
__________________________________
Real Estate _______________________________
Assessee
__________________________________
Improvements_____________________________
Situs Address
__________________________________
Exemption________________________________
__________________________________
Personal Prop_____________________________
Parcel No./Tax Rate Area
__________________________________
Real Estate _______________________________
Assessee
__________________________________
Improvements_____________________________
Situs Address
__________________________________
Exemption________________________________
__________________________________
Personal Prop_____________________________
By Auditor:
_________________________ Date:________________
Rev. 3/08
Treasurer-Tax Collector Copy______
Assessor Copy______
Auditor Copy______
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