PROPERTY TAX REFUND CLAIM FORM
A claim for this refund has previously been sent. Please see attached for information on documentation that our office needs to release this refund. Please note, refund claim forms received without requested documentation will result in a delay of processing.

INDEX # : 2019005319566 AMOUNT : $44.03
ASSESSMENT # : 108090019 TAX YEAR : 2019
 
NAME(S) :
CURRENT MAILING ADDRESS :
CITY, STATE : ZIP :
PHONE NUMBER : EMAIL :
GROUNDS UPON WHICH THE CLAIM IS BASED:
Please state the grounds upon which you are claiming the refund and attach all required identification and supporting documentation to your claim. Please refer to the instructions for further details. Failure to provide the required documents may result in the claim being denied and returned to the sender. As a result, claimants are requested to provide as much information as possible in order to expedite our review process and to substantiate the claimant’s right to the unclaimed refund.
How did you find out about this claim?
Newspaper Web Site
Contact from City/County Other (please specify):
I state that I am the rightful claimant to the overpayment of taxes made on the above-referenced index number/Assessment number. I certify (or declare) under penalty of perjury that the foregoing is true and correct. Furthermore, I agree to indemnify and hold harmless the County of Riverside, its officers, and its employees from any loss resulting from the payment of this claim.

NOTE: YOUR SIGNATURE(S) MUST BE NOTARIZED IF THE CLAIM IS OVER $500.
Date: Signature: Printed Name:
Title (if applicable): Company (if applicable):

NOTARY ACKNOWLEDGEMENT

State of California County of _____________________________}

ss.  On _____________________________________ before me, 

____________________________________________________,
Notary Public, personally appeared

_____________________________________________________,
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to this document and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signatures(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal.
 
Signature
(seal)
SEND COMPLETED CLAIM TO:
Ben J Benoit Auditor-Controller P.O. BOX 1326 Riverside, CA 92502


Property Tax Unclaimed Refund Claim Requirements

In order to process your claim, please use this instruction sheet to determine and provide the appropriate documentation which you are required to submit along with your completed Property Tax Refund Claim Form. Claim forms that are submitted to our office without documentation will result in a delay in the processing of your claim.
NOTE:
YOUR SIGNATURE(S) MUST BE NOTARIZED IF THE CLAIM IS OVER $500.

All claimants must refer to SECTION A for the required documentation. If you are a claimant for a business, refer to SECTIONS A and B for the additional specified documentation required for your claim. If you are an HEIR or BENEFICIARY of the deceased owner, refer to SECTIONS A and C for the additional specified documentation required for your claim.
SECTION A: CLAIMANT IDENTIFICATION

All documentation listed in this section is required for each claimant:

  • Copy of a current government issued photo identification (i.e., driver license, state identification card, passport, etc.)
  • Documentation proving proof of payment for the fiscal year(s) of the refund in question. Examples of proof may include: copies of canceled checks, bank statements, escrow papers showing breakdown of payments, etc.


                                        OR

  • Documentation proving proof of claimant’s ownership. This information must indicate the property address in question. An example of proof is a copy of the tax bill for the property / fiscal year in question.


Third Parties are required to also submit one of the following:

  • Notarized Authorization for Agent to Collect Property Tax Refund on behalf of claimant
  • Notarized Assignment of Right to Collect Property Tax Refund on behalf of claimant
  • Notarized Statement Giving Rights to Collect / Claim on behalf of claimant
SECTION B: BUSINESS IDENTIFICATION

ALL documentation listed under SECTION A is required in addition to the items indicated below. This documentation is intended to illustrate the connection between the Company indicated on the refund and the signatory of the claim form:

  • Personal Business Card for each claimant
  • A notarized affidavit completed by an officer and / or business owner allowing you to claim such funds as an employee of the named account
  • Owner of the Named Account is also required to submit any business related documentation naming proprietor as the owner


Corporations

  • Articles of Incorporation
  • Copy of Filed Statement of Information (Domestic Stock and Agricultural Cooperative Corporations)
  • If a copy of the Filed Statement of Information is not a available, please provide a copy of the corporation’s signed minutes indicating the resolution of the corporation’s officers and / or amendments to Articles of Incorporation illustrating the corporation’s officers
  • Documentation showing the connection between the named corporation and other corporations, limited liability companies, limited partnerships, successor-in-interest, subsidiaries


Limited Liability Companies (LLC’s)

  • Copy of the Filed Statement of Organization
  • Copy of the Filed Statement of Information (Domestic Stock and Agricultural Cooperative Corporations)
  • If a copy of the Filed Statement of Information is not a available, please provide a copy of the Limited Liability Company’s signed minutes indicating the resolution of the company’s officers and / or amendments illustrating the company’s officers
  • Documentation showing the connection between the named limited liability company and other corporations, limited liability companies, limited partnerships, successor-in-interest, subsidiaries


Limited Partnerships (LP’s)

  • Copy of the Filed Statement of Organization
  • Copy of the Filed Statement of Information (Domestic Stock and Agricultural Cooperative Corporations)
  • If a copy of the Filed Statement of Information is not a available, please provide a copy of the Limited Liability Company’s signed minutes indicating the resolution of the company’s officers and / or amendments illustrating the company’s officers
  • Documentation showing the connection between the named limited liability company and other corporations, limited liability companies, limited partnerships, successor-in-interest, subsidiaries


Native American Tribes

  • Constitution and Bylaws of Tribe
  • Documentation for the Tribal Council indicating the Tribal Council Members
SECTION C: DECEASED OWNER

ALL documentation listed under SECTION A is required from Heir(s) and / or Beneficiary(s) in addition to the items indicated below:

  • Certified Death Certificate(s) for deceased owner(s)
  • Complete copy of the Court Ordered Distribution of the Decedent’s Estate
  • If the distribution of the estate was not ordered by a court, you will need to submit a complete copy of the Decedent’s Will and / or Trust Agreement


CONFIRM THAT ALL REQUIRED DOCUMENTS ARE INCLUDED WITH YOUR COMPLETED PROPERTY TAX REFUND CLAIM FORM AND SEND ENTIRE PACKAGE TO:

  Ben J Benoit
  Auditor-Controller
  P.O. Box 1326
  Riverside, CA 92502

All inquires pertaining to Property Tax Unclaimed Refunds may be directed to our office via email at PropTaxUnclaimed@rivco.org. Please include your contact information as well as the index number regarding your inquiry.