HomeMy WebLinkAbout20220801140256CITY OF A
LAKE .?LSIAOKE
�,5� DREAM. EXTREME
Public Records Request
1. REQUESTOR INFORMATION
First Name *
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* Ext.
2. CHOOSE THE TYPE OF DOCUMENTS YOU ARE REQUESTING
Select all that apply. If not shown, please provide description below. *
❑Agendas, Minutes, Resolutions, or Ordinances
❑ Building Permits
❑ Business License
❑ Conditions of Approval
❑ Easement
❑ Fire Reports
❑ Grading Permits
❑ Intersection Video
❑ Soil Report
&Violations
❑ Bid Results
❑ Building Plans
❑ Certificate of Occupancy
❑ Conditional Use Permit
❑ Environmental Records
❑ Grading Plans
❑ Hydrology Report
❑ Liens
❑ Police Reports
❑ Street Improvement Plans (no water or sewer)
❑ Other ❑ Unknown !v ,
3. INFORMATION OF DOCUMENTS REQUESTED
If document was not mentioned above, provide a brief description
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Property Address of Documents Requested
Street Address _
4. SIGNATURE
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By submitting this request, I understand that I am responsible for aV charges applicable by law for the reproduction of
said records aqd pia! the City does not have toroduce records y/,, format in which they do not currently exist.
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Date
STATE OF CALIFORNIA
FRANCHISE TAX BOARD
PO BOX 942867
SACRAMENTO CA 94267-0041
Intercept Funds Notice - State Tax Refund
TERRANCE D THIELEN
Notice Date:
03/14/2022
Account:
121-00836-99
Tax Year: 2021
Why You Received This Notice
One or more agencies requested we intercept your state income tax refund to pay a debt their records state you owe.
California law requires us to send your refund to the requesting agency. (California Code Sections 926.8 and 12419)
Funds Summary
Original Amount of Your Funds Requested
State Income Tax Refund by the Agency Remaining Refund
$188.00 $188.00 $0.00
What You Need to Do
Review your records, the agency name, and account information to determine if you agree or disagree that you owe
this debt.
If You Agree
No action is required. The intercepted amount will be sent to the requesting agency to pay your debt and any remaining
amount will be sent to you. f
If You Disagree
Contact the requesting agency if you:
• Already paid the debt. )j —0 0 g _g & — q q �
• Need additional information about the debt.
• Believe your refund was intercepted in error.
The Franchise Tax Beard Woes not have detailed information about the debt or the authority to cancel it.
Agencies That Requested Your Refund
Agency Name
CITY OF LAKE ELSINORE
P O BOX 7275
CODE COMPLIANCE
NEWPORT BEACH CA 92658-7275
800.969.6158
Agency Account
FTB 4141A ENS (REV 09-2018) -� 4141010 918 81
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Amount Intercepted
$188.00
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