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I, ____________________________(your name) Applicant for Application for Changed
Assessment, appoints Property Tax Refund,LLC as my Agent:

Property Address :___________________________________________

Assessor’s Parcel Number:_____________________________________
Agent Information : Property Tax Refund,LLC
32108 Alvarado Blvd, No. 244
Union City, CA 94587
Ph : (866) 309-6948
Fx: (925) 245-3894

Property Tax Refund, LLC is authorized to act on my behalf for all matters pertaining to the
Application for Changed Assessment for Tax Year 2008. Property Tax Refund, LLC is authorized
to appear at any hearings before the assessment appeals board on my behalf, enter into situations
and/or otherwise settle any and all other issues pertaining to the Application for Changed
Assessment. My agent has knowledge of the property under assessment reduction consideration,
will provide me with a copy of the application and will answer all questions and inquiries on my
behalf. I understand my application for reduction in assessment may be denied or have no change
in value. Property Tax Refund,LLC has not and cannot guarantee a reduction in assessment in
connection with this appeal.

__________________________ __________________________
Date Signature/Title (see below)

NOTE: If application is an individual person(s), sign as Owner. If the applicant is a corporation or

other entity, the authorization must be signed by an officer and/or authorized employee. The
signer’s title must be designated in the articles of incorporation and/or legal documents and be
filled in.


Upon receipt of a signed authorization form and initial one time fee of $265(Option A), Property
Tax Refund will start processing the property tax reduction with the County. However, for those
who choose to pay later, a sign up fee of $5.00 is required to start the property tax reduction
process. Once the property tax reduction is successful, a fee of $499(Option B) is payable to
Property Tax Refund, LLC. Please circle below the payment method that you agree and feel
A. Payment Option A – One time fee of $265

B. Payment Option B – Sign up fee of $5.00 and $499 payable upon successful
property tax reduction
Once Property Tax Refund, LLC files any correspondence, paperwork or appeal applications on
your behalf, we can not guarantee a refund or reduction in assessed value. However, we will
make every attempt to achieve a refund and reduction for you. If your claim is denied by the
County Assessor for any reason, you will receive a 100% refund of your initial $265(Option A)
payment. Our service is not a guarantee to get you a refund; however we have been very
successful in obtaining refunds and/or reductions in assessed value for our clients that are eligible
for this service.

Property Tax Refund, LLC is not responsible for actual refund or reduction. Refunds and
reductions are obtained directly from your local County Tax Assessor office.

Credit Card # __________________________

Expiration Date ________________________

Name on Card _________________________


(510) 477- 9236 OR EMAIL TO