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BOE267L (P1) REV. 14 ×1114) WELFARE EXEMPTION SUPPLEMENTAL AFFIDAVIT, HOUSING LOWER INCOME HOUSEHOLDS William F. Rousseau ClerkRecorderAssessor 585 Fiscal Dr., Room 104 Santa Rosa, CA 95403 ×707×
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This claim is filed to report a legal request or demand for compensation or benefits.
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The purpose of this claim is to seek financial compensation or other benefits for damages or losses incurred.
Information such as the date and location of the incident, details of the damages or losses incurred, and any supporting documentation must be reported on this claim.
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