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2. PLEASE REVIEW THIS IMPORTANT INFORMATION BEFORE COMPLETING AND SUBMITTING YOUR REQUEST
4. INSTRUCTIONS
   1. Complete the information below and check the confirmation box to electronically sign and date the form. The form must be signed by an owner whose name appears on the title of the property or his/her authorized agent.
   
   2. Gather all supporting documentation (if available) to substantiate your request. Please redact any social security numbers or confidential information on your support documentation. If documentation is not available please indicate that in your description.
   
   Examples of supporting documentation may include, but are not limited to, the following:
   • Note from physician or medical staff • Hospital release form indicating date of admission
   • Employer notification of employment release due to COVID-19
   • Employer notification of business closing/reduced hours due to COVID-19
   • Document showing owner/operator unable to conduct business due to COVID-19
   
   3. Mail supporting documentation, along with a check for any outstanding taxes that have a delinquent date between March 31, 2020 through April 30, 2020 (penalties excluded) to:
   Nevada County Tax Collector, PO Box 128, Nevada City, CA 95959
   OR
   Email to ttc@co.nevada.ca.us and pay online at https://www.mynevadacounty.com/372/Pay-Your-Tax-Bill
   
   If after review, the penalty cancellation is denied, the assessee will receive notice that the penalties are due and payable.
   Please contact this office with any questions you have concerning the request for cancellation of penalties process.
   
   Under Revenue and Taxation Code (RTC) section 4985.2, a taxpayer may request cancellation of any penalty assessed on secured, supplemental, or unsecured property taxes by completing and submitting a request to the tax collector. However, penalties incurred as a result of certain financial conditions (e.g. bankruptcy) may not qualify for cancellation.
   
   RTC subsection 4985.2(a) reads as follows:
   
   Any penalty, costs, or other charges resulting from tax delinquency may be cancelled by the auditor or the tax collector upon a finding of any of the following:
   (a) Failure to make a timely payment is due to reasonable cause and circumstances beyond the taxpayer’s control, and occurred notwithstanding the exercise of ordinary care in the absence of willful neglect, provided the principal payment for the proper amount of the tax due is made no later than June 30 of the fourth fiscal year following the fiscal year in which the tax became delinquent.
8. California Revenue and Taxation Code Selection:*
   -- Select One --R&TC Section 2512 - Proof the United States Postal Service took custody of the paymentR&TC Section 4911 - Payment was made to an incorrect propertyR&TC Section 4985 - An error expressly made by the County of NevadaR&TC Section 4985.2 - Beyond taxpayer's control

   Please select the California Revenue and Taxation Code Section, which you believe supports your request for penalty cancellation.
10. Bill Type*
    -- Select One --Annual Secured Property Tax BillSupplemental Secured Property Tax BillAdjusted Annual Property Tax BillAdjusted Supplemental Property Tax BillStatement of Prior Year TaxesUnsecured Property Tax Bill
11. Tax Year (i.e., 2019)*
13. Annual Secured Property Tax Bill Assessor's Identification Number:
    A 12 digit number assigned to a piece of real property. This number is found on your Annual Secured Property Tax Bill. Only use numbers
14. Unsecured Assessment Number
    A 12 digit number found on your Unsecured Property Tax bill. Only use numbers.
15. Assessor's Parcel Number (APN)
17. Taxpayer Name:*
19. Mailing Address:*
20. Address 2 (optional):
22. City:*
23. State:*
    -- Select One --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
24. Zipcode:*
26. Phone Number:*
28. Email Address:*
32. Reason for Request of Penalty Cancellation – COVID-19 Impact*
    -- Select One --Economic/Financial HardshipHealth Concerns Other
34. Please fully describe the reason(s) for making this request.*
    Please fully describe the reason(s) for making this request. The reason for this request must be associated with an economic/financial hardship and/or an inability to tender payment due to the County’s or State’s stay at home order or other circumstances associated with the COVID-19 pandemic.
36. The failure to pay timely was due to circumstances beyond my control, occurred in spite of the exercise of ordinary care, there was no willful neglect involved, and was for the following reason(s).
    Attach additional pages if necessary
38. Notes:
    Please enter, optionally, a brief description of the nature of your request for penalty cancellation. Please note this field is limited to 500 characters, including spaces, returns, and other system control characters.
42. Confirmation*

    1. Check the box to declare and sign

    I declare under penalty of perjury that the information contained in this claim is true and correct and that I am signing as the assessee of record or his/her authorized agent. I understand that storage of contact information, including but not limited to names, telephone numbers, and email addresses in the TTC's request database may constitute a public record which may be subject to disclosure under the California Public Records Act, Government Code Section 6250.
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44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit Submit and Print

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