California Code, Streets and Highways Code - SHC § 6467

1. The ___ of ___ by Resolution of Intention No. ___, passed on the ___ day of ___, 20___, and proceedings subsequent thereto, levied an assessment against property owned by ___ in the sum of ___ dollars ($___).

2. Said assessment was levied on the ___ day of ___, 20___; notice thereof was recorded in the office of the County Recorder of the County of ___, on the ___ day of ___, 20___.

3. Said assessment was levied in an assessment district known and described as “___.”

4. The assessment number of said property, as shown on the assessment diagram and in the assessment roll is No. ___, and the property designated as assessment number ___ and which belongs to ___ is described as follows:

(insert description)

5. Said assessment is payable in not more than ___ (___) annual installments, the first installment of which shall be June 2, 20___, and the last of which will be payable June 2, 20___.  Said installments will be in even annual proportions of the whole amount.  Payments of principal shall be represented by coupons attached to said certificate.

6. Interest will accrue upon said unpaid amount from the ___ day of ___, 20___, at the rate of ___ percent per annum until the whole of the principal and interest thereon shall have been paid in full.  The interest is payable semiannually, by coupon, on the second day of December and June, respectively, of each year a principal payment coupon matures.

7. The officer or board whose duty it is to levy taxes on behalf of the owner of said property hereinabove described, is obligated to include in the next tax levy an amount, in addition to moneys for all other purposes, sufficient to pay ___ (___) or more of the principal of said assessment with interest on the unpaid principal of the assessment to date of payment and is obligated to include in each succeeding tax levy a like ___ (___) amount or more in addition to moneys for all other purposes until the principal of said assessment and all interest on the unpaid portions thereof shall be paid.  Said tax levy shall be made notwithstanding that said tax levy exceeds the maximum tax rate that may otherwise be imposed by law.

8. In the event that the officer or board whose duty it is to levy taxes fails to provide for a tax levy to pay and discharge the principal of the assessment and the interest thereon, the owner of this certificate may compel the levy thereof in the manner hereinabove set forth by writ of mandate.  No statute of limitations shall bar any right provided for herein to enforce the collection of this assessment and any interest due thereon until four years after the maturity of the last coupon of principal and interest due on this certificate.

9. The owner of this certificate described herein may use mandamus or other appropriate remedy to compel the officer or board whose duty it is to levy taxes for said obligated owner to levy an amount in a given year equal to ___ (___) of said assessment and interest on the unpaid portion thereof and may continue to use mandamus or other remedy to cause a like ___ (___) amount and interest to be levied each year until the whole of said assessment and all interest due has been paid.

10. If an owner of this certificate is successful in any action to compel the levy of a tax under this certificate the owner shall be awarded reasonable attorney fees as fixed by the court and costs and said attorney fees and costs shall be included in the tax levied to pay the same.

11. This certificate together with interest is payable to bearer at the office of the ___ treasurer of the ___ of ___ upon presentation of the coupons representing principal and interest thereon.  Upon payment in full it shall be surrendered to the ___ treasurer for cancellation.

In witness whereof, said ___ has caused this certificate to be signed by its treasurer and has caused its clerk to affix thereto its corporate seal all on the ___ day of ___, 20___.