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TAX REIMBURSEMENT FORM

To facilitate the processing of your property tax reimbursement (if prescribed in your lease agreement), please complete one tax reimbursement form for each property tax reimbursement requested. Please attach the documents necessary for the processing of your request (see list below).

Date: ________________________________________________

SBA Side ID Number: ________________________________________________

Name & Address of person or

Jurisdiction to be reimbursed/paid: ________________________________________________

Street Address: ________________________________________________

Street Address: ________________________________________________

City, State & Zip Code: ________________________________________________

Documents Supplied:

Copy of relevant tax bills: _______

Letter from Assessor: _______

Property Card/Parcel Record Card: _______

Proof of Tax Payment: _______

Comments:

Use the contact information below:

Email to: PropertyTax@

Fax to: 561-226-3529

Telephone: (800) 487-7483, Ext. 9324

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