APP 004 Rev. (01-20)
Assessor-Recorder-County Clerk
222 West Hospitality Lane
San Bernardino, CA 92415-0311
(909) 387-8307 ● 1 (877) 885-7654
www.SBCounty.gov/arc
Request for 571-L Business Property Statement
Request Account number and BIN number
Assessor’s Parcel Number:
Location of Property:
Business Owner Name:
Doing Business As:
Type of Business:
Start Date of Business at this Location:
Please provide contact information in case we have any questions regarding this request.
Print Name: Title:
Daytime phone number: Date:
Email:
Please complete this form, then
Fax it to (909) 386-8722
Mail it to the San Bernardino County Assessor’s Office
or,
Email it to personalproperty@arc.sbcounty.gov
Mailing Address (all forms and
tax bills will go to this address):
Mailing Address for this Property Statement
Request (only if different from above):
