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BROWSE COUNTY OF LAKE (CA) FORMS

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INFORMATION FOR BUSINESSES
CLOSED, SOLD, OR MOVED
COUNTY OF LAKE
RICHARD A. FORD
Assessor-Recorder
255 N. Forbes St, Rm 223
Lakeport, CA 95453
Assessor’s Office: 707-263-2302
Recorder’s Office: 707-263-2293
Fax 707-263-3703
Please complete this form and return to the Assessor’s Office if the business was
closed, sold, or moved out of Lake County prior to January 1,______ .
Assessment No:___________________________________________________________
Assessee Name:___________________________________________________________
DBA ____________________________________________________________________
Current mailing address: ____________________________________________________
City/ State/Zip: ____________________________________________________________
Contact telephone number: __________________________________________________
1. If closed, date closed:_________________________________________________
What did you do with the business equipment?______________________________
___________________________________________________________________
___________________________________________________________________
2. If sold, date sold:_____________________________________________________
Buyer’s name:_______________________________________________________
Buyer’s address:_____________________________________________________
Buyer’s city/state/zip:__________________________________________________
Buyer’s phone number: ________________________________________________
3. If moved out of Lake County, date moved:_________________________________
New location: ________________________________________________________
________________________________________________________________________
Signature of assessee or authorized agent Date
________________________________________________________________________
Print name of assessee or authorized agent
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Completed 6 August 2020

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