Siskiyou — Solid Waste Exemption and Refund Application

Source: https://www.siskiyoucounty.gov/sites/default/files/fileattachments/general_services/page/5171/solid_waste_exemption_refund_application.pdf

Solid Waste Exemption & Refund Application

A. The dwelling or commercial building has been totally destroyed by:

An Act of God: _______________

Other. Please describe below under Describe Reason

B. The dwelling or other structure was occupied not more than 30 days from July 1 to
June 30 in the fiscal year(s) indicated.

C. The property has no dwelling/habitable structure/improvements

D. The property has an incorrect solid waste levy

Total number of exemptions requested: ___________ Tax year(s): ________________________

Describe Reason(s):

Property Owner:_________________________________________ APN _____________________

Mailing Address:__________________________________________ Tax Rate Area ____________

City: _________________________ State _______ Zip: ___________ Phone: _________________

Under penalty of perjury, I state to the best of my knowledge and belief that the information I have indicated is correct regarding the property identified by this parcel/assessment number (APN).

Signature: ___________________________________________ Date: _______________________

Please Note: If you feel your solid waste fee is in error, contact the Solid Waste Department for detailed study and review. If the Solid Waste Department has denied an exemption or reclassification, property owners may appeal the action to the Board of Supervisors within thirty (30) days after receiving such notice.

Please Return This Form to: Siskiyou County General Services Sanitation Division 190 Greenhorn Road Yreka, CA 96097

Do Not Write on Page 2. The fields on that page are for Sanitation approval and calculations.

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Sanitation Approval: __________________________________ Date: ______________________

Reason: _______________________________________________________________________

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TAX YEAR— 2022/2023 2023/2024 2024/2025 2025/2026 2026/2027

Original Code

Change to Code

Tax Bill Number

First Payment

Second Payment

Orig. Levy Amt.

Chg Levy Amt.

Refund

Check Number

Changed Bill No.

Affidavit

Permanent Change

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