Mike Sullivan Harris County Tax Assessor Collector

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ris County Tax Assessor-Col
Post Office Box 4520
Houston, Texas 77210-4520
Step 1. Identify
Account number (7 or 13 digits)
Tax year
yourself and
the property.
Refund requested by:
Name
Address
This Application
City, State, Zip
must be complete and
Daytime phone #:
Email address:
must be signed by the
Description of the property (legal or street address)
taxpayer to be valid.
Step 2. Who
Please check one of the following:
My mortgage company withholds taxes from my monthly payment.
normally pays your
I pay my property taxes directly.
property taxes?
If you bought or sold this property during the tax year, please complete below:
MONTH/YEAR
I bought this property during the tax year.
This information is
I sold this property during or after the tax year.
needed to assure your
PLEASE INDICATE NAME OF YOUR MORTGAGE AND/OR TITLE COMPANY
refund is made to the
proper party.
Step 3. Provide
Please check one of the following and state reason:
Overpaid the account (explain:
)
the reason for
HCAD exemption or value reduction granted (date of change:
/
/
)
this refund.
Paid incorrect account (explain:
)
Step 4. Provide
Payment made by
Check No.
Date paid
Amount paid
payment
information.
Total amount paid by mortgage company or others
Attach copies
TOTAL AMOUNT PAID (sum of the above amounts)
of cancelled checks
TOTAL PROPERTY TAX OWED
for all payments you
AMOUNT PAID MINUS AMOUNT OWED
made on this account.
Step 5. How do you
Please check one of the following:
want the refund
Mail refund to above mailing address (Step 1)
handled?
Transfer this payment to account #__________________________tax year ____________
Reapply this overpayment to several accounts (Please attach a list of accounts)
Step 6.
By signing below, I hereby apply for the refund of the above-described taxes and certify that the
Sign the form.
information I have given on this form is true and correct. I understand that any person who makes a
false entry upon this record shall be subject to fines and/or imprisonment.
SIGNATURE OF TAXPAYER (REQUIRED)
DATE
Unsigned applications
cannot be processed.
AC-501 (1/29/2003)

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