Fillable Parcel No. Date Damage must have occurred due (San Bernardino County Assessor-Recorder-Clerk)

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Parcel No. Date Damage must have occurred due (San Bernardino County Assessor-Recorder-Clerk)

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BOB DUTTON
ASSESSOR-RECORDER-COUNTY CLERK
COUNTY OF SAN BERNARDINO
ASSESSOR’S OFFICE
222 West Hospitality Lane
San Bernardino, CA 92415-0311
www.sbcounty.gov/arc
(909) 387-8307 – 1-877-885-7654
Parcel No. Date
Damage must have occurred due to misfortune or calamity and amount to at least $10,000. Failure to file within
12 months of the damage may result in a reduction of property tax relief.
Name Contact Telephone No. ( )
Email Address (optional)
Mailing Address
Street City State Zip
Property Address
Date of Damage Cause of Damage
TYPE OF DAMAGED PROPERTY
Your estimate of market value before damage $ Real Property
Business Personal Prop.
Your estimate of market value after damage $ Boat or Aircraft
Manufactured Housing
Describe the property damage
I certify (or declare) under the laws of the State of California that the damage occurred through no fault of my own
and the above information is true, correct and complete to the best of my knowledge and belief.
Signature Date
ASSESSOR’S USE ONLY
MARKET VALUE
VALUE REDUCTION
% Good
After/Before
20 Roll
Reads
Roll
Should
Read
BEFORE
AFTER
LAND
IMPROVEMENTS
PERSONAL PROP.
HOX
Other Exemption
Net
DAMAGED PROPERTY REASSESSMENT
APPLICATION
(Mobilehome)
MONTHS IN FISCAL YEAR
REGULAR
APPRAISER’S SIGNATURE
DISTRICT SUPERVISOR’S SIGNATURE
DATE
DATE
ARP 033 Rev. (06-19)
P. 30-16
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Parcel No. Date Damage must have occurred due (San Bernardino County Assessor-Recorder-Clerk)

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Completed 31 January 2021

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