Withdrawal of an Application Assessment Appeals Board

Withdrawal of an Application Assessment Appeals Board

COUNTY OF LOS ANGELES
B4 KENNETH HAHN HALL OF ADMINISTRATION / 500 W. TEMPLE ST., LOS ANGELES, CA 90012
PHONE (213) 974-1471 / FAX (213) 217-4979

ONLY APPLICANT OR ATTORNEY/AUTHORIZED AGENT MAY WITHDRAW AN APPEAL
Received Date*

MonthDayYear

Hour Minutes
Date

MonthDayYear
Name of Applicant*
Application Number*
Assessor's I.D.*
Map Book - Page - Parcel or Bill Number
Please select whether you would like to withdraw ALL or PARTIAL parcels*

I am withdrawing all parcelsThis is a partial withdrawal
If you have additional parcels you would like to withdraw, please list them here in the same format as above (####-###-###). Otherwise leave blank.
View Additional Parcels
If you are withdrawing your appeal because it has been resolved with the Assessor's Office

please check this box
Please explain any other reason(s) for withdrawing (optional)
The undersigned is no longer interested in pursuing the appeal and hereby WITHDRAWS all parcels/bills on the above application.
Email*
Signature*

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Print Name*
Title*

OwnerAgentAttorneySpouseChildParentPerson AffectedRegistered Domestic Partner
Preview Acknowledgment*

I have clicked the Review/Print PDF button and reviewed the final document. I certify that all the information and statements in the document are accurate and complete.
Type of Form
Web Based Form
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