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APPLICATION TO FILE A PENALTY ABATEMENT 1-041
BOARD OF SUPERVISORS OF THE COUNTY OF CONTRA COSTA
(California Revenue and Taxation Code Section 483)
Application for Abatement of Penalty )
for Failure to File the appropriate )
Change of Ownership Form (Sales Form) )
to be filed with the Clerk of the )
Board of Supervisors, 651 Pine Street,)
Froom 106, Martinez, California 94553 )
Phone: (415) 372-2371 )
Assessor's Parcel Number 44.6 D/ 0 01-Y-�
Name 1--Q,NL_Mx1 i a_9J c+ e4-L2- - PhoneZ-
Last I First Middle
0
Address oZoZ 6
Street City Stat , Zip
Amount of Penalty Date of Notification by Assessor 44-t. I
Reason for Request of Penalty Abatement
71
Has Ownership Change Statement (Sales Form) been filed with Assessor?
Yes If yes, date filed
No
I declare under penalty of perjury that the foregoing is true and correct.
)+I R-(1 0 4nak&1*_1 � _]�"
Date gnature of App is
4,n�� /U
Mailing address of applicant if
different from above
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To Be Completed by Assessor
Date of First Request for Change of Ownership Statement _47w(-cam Oe' r l;-4�Qc'7,
Ownership Change Statement filed: Yes ,t/ No Date Filed - o
Abatement recommended: Yes No� ;
Date ignat -Ass
WARD ORDER By unanimn-as cote of the Supervisors present
(Check one only)
( ) This Application for penalty abatement is GRANTED.
(X) This Application for penalty abatement is DENIED
I certify that this is a true and correct copy of the Board's Order
entered in its minutes for this date.
Phil Batchelor, Clerk of the Board of
Supervi ors and County Administrator
Dated By
Deputy Jerk
cc: Applicant
Assessor
Auditor-Controller
APP AWN.1