Description of the property damaged and the extent of damage (use additional sheet if necessary):
Brief statement of facts and circumstances regarding the cause of damage:
Please attach cost estimate for repair or insurance cost breakdowns. Also attach proof of the date of damage, such as
insurance report or fire department report.
is important to understand that this program provides proportional amounts of property tax relief. In many cases
the savings may be significantly less than 1% of the damage amount due to the fact that assessed values set
pursuant to Proposition 13 may be considerably lower than current market values.
The following example assumes a $20,000 loss to improvements, a six month period for repairs, assessed values on the
tax bill of $75,000 on land and $150,000 on the improvements, market values before the loss of $150,000 on the land and
$200,000 on the improvements and an approximate tax rate of 1.15%.
$20,000 ¸ $200,000 = 10.00% x $150,000 x 1.15% x 6 ¸ 12 Months
Ratio of Loss to Repair period (months)
Loss ¸ Market Value market value of Assessed Value
Approximate ¸ Total months in Tax Dollar
of Improvements = improvements x of Improvements x Tax Rate x fiscal year Reduction
For additional information you may contact the Real Property Division at (408) 299-2401 or FAX (408) 298-9439, or the
Business Division may be contacted at (408) 299-3821 or FAX (408) 298-9441.
I hereby apply for reassessment of the property described above. The property was damaged or destroyed
without my fault.
declare that I was the owner of the property, or had it in my possession and control at the time
of the loss, and that I am responsible for the taxes on the property. 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.
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