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• Application for Proration of Property Taxes I. • �,► :_ Due to Damage by Fire or Act of God Oregon Revised Statutes(ORS)308.425 nstructions: I •Application for proration of property taxes may be made for the tax year of the property damage/destruction.If approve,ltu gZayoeduq�-tbe amount of tax due or result in a tax refund.The tax year is from July 1 to June 30. Hti IIJJ�IVV UUUU�IVV II YY •Your application must be filed within 60 days of the damage or by June 30 of the tax year in which the damage occurreN543EiSkaa is later. •File your application with the county tax collector of the county in which your damaged property is located. Applican's name Phone ( �oIr��'a M be 3 no-62.63 Mailing address Email� (optional) I I, cityQO/4:A •CC77't �� N�� State ZIP codel� U Oi .. 1358 Location and description of damaged or destroyed property Assessor's account number R41196 / 541196 Location of property(if different from above) Section Township Range Tax lot number 22806 Jennie Rd SE 1 g DDS oci ��__�[[2E/lots, 4 L OO4(p 00 Description property Lyons, OR 97358 /,r(Jl/ i(lcAdd sluff r peisci L Date of damag Cause CI of damage Q�� i�� ire(attach fire department report) Act of God (describe): Damage oc urred to Wand jKuilding sonal property ❑Manufactured structure Describe�pdamage Ct d ' � ver;43 . - 'e, ail .4e(aIli ' I s 1.,-.. 6,als e hameci,,v- I Application for proration of tax rspam applying to have the above property examined for proration of property taxes per ORS 308.425.Application must be submitted within 60 days of damage or June 30,whichever is later. Whether my property is damaged or destroyed will be determined by the County Assessor's office.If the assessor determines my property is only dam- aged,I must notify the tax collector of the date that the damage is repaired.Such notice will serve to inform the tax collector of their duty to calculate and finalize the tax proration. Declaration I declare under the penalties for false swearing [ORS 305.990(4)]that I have examined this document and to the best of my knowledge it is true,correct, a d complete. &ill X r Applica 's si nature Date —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: 1.-S-11 Clerk: a Date received: (• 4.2 I Clerk: r V 0 So Damaged property: This year Land and improvements: !` _.-- Real market value RMV) e!ppre RMV after Date rebuild complete: Months prorated: fire/act of God:3 le9C. fire/act of God:I82.5y0 Assessed value(AV nbeforeValue Amount of adjustment/refund: `' fire/act of God: (o;O u i o percent of loss: O. 0 59 L Destroyed property: This year Personal property: Months prorated: RMV before RMV after 1 fire/act of God: fire/act of God: 68k AV before Amount of adjustment/ Z fire/act of God: Value percent of loss: Remarks: Date property visited:I^l(. 7,4 ❑Damaged estroyed 05170 mRrira 150-310-083(Rev.12-15)