Application For Tax Segregation Form - Santa Cruz County, California Page 2

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INSTRUCTIONS FOR TAX SEGREGATION APPLICATION
Items 1 through 8 must be completed before submitting to the Assessor. Applications may be submitted personally or by
mail or fax.
IN PERSON OR BY MAIL: Santa Cruz County Assessor, 701 Ocean St, Rm. 130, Santa Cruz CA 95060
FAX: (831) 454-2495.
NOTE: Only current, unpaid tax bills can be segregated. If application is filed on or before December 1 (April 1 for second installment)
delinquent penalties will not be applied and payment of the current tax is not required until you receive a correct bill. If you pay the
original bill, your segregation request will be cancelled.
The information for entry on this application (Items 1-8) is described in the following instructions:
Item 1. DATE: Enter Month, day and year.
Item 2: PARCEL NO : Enter parcel number as it appears on the current tax bill (8 digits - begins with 0 or 1 as in 010-102-83 or
103-161-12).
Item 3. TAX CODE AREA : Enter tax code area as it appears on the current tax bill (example: 02077).
Item 4. ASSESSEE: Enter owner of record as of preceding January 1 as it appears on the current tax bill. Enter current mailing
address of said owner and property address of the parcel.
Item 5. DOCUMENT : ITEM 5 is very important. Required information can be found on the grant deed, usually in the upper right-
hand corner.
Item 6. APPLICANT : Enter name, mailing address, business phone number and residence phone number of the applicant for this
segregation. It may be the buyer, seller, or agent for either.
Item 7. APPLICANT’S SIGNATURE : The signature of the applicant (Same as in Item 6).
Item 8. PROCESSING FEE : Processing fee of $36.00 per parcel must be included at the time the application is submitted.
DO NOT WRITE BELOW ITEM 8 - FOR OFFICIAL USE ONLY

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