Statement of Change Form

Statement of Change Form

NEVADA COUNTY ASSESSOR
Owner Name*
Assessment
Assessor's Parcel Number
DBA*
Optional
Best mailing address for future business assessment correspondence
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Location*
Please note any of the following changes to your business in Nevada County and file this form with the Assessor's Office. The sale,closure or move after lien date January 1 does not relieve the owner on January 1 of the tax liability
Sold Business
*Please provide copy of purchase agreement if available
Date Sold*

MonthDayYear
New Owner’s Name*
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Sales Price of Equipment/Fixtures*
Rounded to nearest whole dollar
Leasehold Improvements
Rounded to nearest whole dollar
Moved Within County
Date Moved*

MonthDayYear
New Location (within the county)*

Street Address

Street Address Line 2

CityState

Zip Code
Moved Out of County/State
Date Moved*

MonthDayYear
New Location (outside the county)*

Street Address

Street Address Line 2

CityState

Zip Code
Changed (either DBA or Ownership Name)
Which one?

DBAOwnership name (name only - if sold user prior option)
New DBA or Ownership Name...
Permanently Closed Out Business
Date Closed*

MonthDayYear
What happened to the Assets?*

0/50
Never Opened This Business
No Other Business in Nevada County
Please provide a copy of the purchase agreement

Cancelof
Acquired Existing Business
Prior Owner’s Name*
Date Acquired from Prior Owner*

MonthDayYear
Prior Owner's Mailing Address

Street Address

Street Address Line 2

CityState

Zip Code
Purchase Price Equipment/Fixtures*
Rounded to nearest whole dollar
Improvements
Rounded to nearest whole dollar
Other Remarks
Elaborate:

Statement of Change Form

Please note any of the following changes to your business in Nevada County and file this form with the Assessor's Office. The sale,closure or move after lien date January 1 does not relieve the owner on January 1 of the tax liability