Placer County Seal Placer County Assessor's Office logo

Matthew R. Maynard, Assessor
2980 Richardson Dr ● Auburn, CA 95603-2640
Telephone: (530) 889-4300 ● Fax: (530) 889-4305
Website: www.placer.ca.gov/assessor
E-mail: assessor@placer.ca.gov

Agency Authorization Form

Important Information

In California, the Assessor is prohibited from disclosing confidential information related to the property or business affairs of another. California requires any person signing Business Property Statements as an agent on behalf of a business owner to have a letter of authorization on file with the Assessor’s Office.

A property owner (assessee) may authorize a designated representative to act as their agent for all related assessment matters, inspection of assessment files, requesting copies of information pertaining to their assessment, changing mailing addresses, or signing of Business Property Statements.

For your protection, our office requires a fully completed Agency Authorization form signed by the owner (assessee) on file before release of any confidential information or acceptance of a Business Property Statement filing as being valid.

Agency Authorizations will remain in effect until the Assessor’s Office receives written notice of cancellation and will automatically expire four (4) years from the date of execution. Once expired, our office requires a new Agency Authorization form to be completed.

It is important to remember that while you have the right to delegate authority to a designated representative, you will assume full responsibility for all actions taken by your agent on your behalf.

I hereby appoint the agency / agent listed below to represent me in assessment matters with the Placer County Assessor’s Office. The authority of the agent is as follows:

This agent is delgated full authority to handle all assessment matters with your office. Agent shall have access to all information and materials that would be available to the owner.

Other (Please specify)

Please specify

This authorization will remain in effect until the Assessor’s Office receives written notice of cancellation and will automatically expire four (4) years from the date of execution.

Agent Information

Agency / Agent Name:

Agent Mailing Address

Agent Phone Number

Agent Email

Owner Information

Owner/Business Name

Please list each Assessor’s Parcel Number (APN) / Assessor’s Business Assessment Number.

APN/ Assessment Number

Attach a list for additional properties. (Click to attach file of additional properties) Accepted file extensions are: .docx, .jpg, .pdf, .png, and .xlsx

The undersigned certifies that they own, possess, control or manage the property referenced in this authorization and that they have the authority to designate an agent to act on behalf of the owner(s). The undersigned retains full responsibility for any and all actions this agent makes on behalf of the owner(s) and acknowledges that the Assessor may require additional information to be furnished on this request.

Assessee Name

Assessee Title (Owner, Corporate Officer, Partner, CPA, Controller, Attorney, Trustor)

Assessee Phone Number

Assessee Email Address

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Agency Authorization (PCA429)

Agency Authorization Form

Agent Information

Owner Information