State Controller's Office Assistance Form

Contact Information

First Name *

Last Name *

Address *

City *

Zip Code *

Phone Number

Ext.

Phone Number Type

Have you already contacted another elected official for assistance with this issue? *

Yes

If Yes, please list any other elected officials you have contacted.

Reason for Request

What do you need assistance with? *

Unclaimed Property

Property Tax Postponement

Duplicate Warrants (checks)

Other

If you selected other, please specify here.

If "Unclaimed Property" selected, please provide: Claim Number or Property Identification Account Number

If "Duplicate Warrants" selected, please provide: Warrant Number

Briefly describe the issue you are having. *

Authorization for Release of Information

Please carefully read the following:

By completing this form, I am requesting the Office of Assemblymember Bryan (the “Assemblymember”) to assist me in working with the State Controller’s Office on my request. I acknowledge that this may require the release of information contained in my records the dissemination of which may be prohibited by law. Therefore, I hereby authorize State Controller’s Office and the Assemblymember to share all relevant portions of my records with each other, and to discuss matters relating to those records and my claim, until my claim is resolved.

I agree that I will not submit any personal identifiable information through this form that is not specifically requested. If the Assemblymember’s office needs additional information the office will contact me to request that information. *

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