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, LQ : Clear Form Application for Proration of Property Taxes For county use only Due to Damage by Fire or Act of God Date received Oregon Revised Statutes(ORS)308.425 — 4 - Zcz� Instructions: •Application for proration of property taxes may be made for the tax year of the property damage/destruction.If approved,this may reduce the amount of tax due or result in a tax refund.The tax year is from July 1 to June 30. •Your application must be filed within 60 days of the damage or by June 30 of the tax year in which the damage occurred,whichever is later. •File your application with the county tax collector of the county in which your damaged property is located. Applicant's name Vince Foley Phone Mailing address 314-249-9802 7527 SE Harrison St Email(optional) Cityvincefoley@gmail.com Portland State ZIP code OR 197215 Location and description of damaged or destroyed property Asse sor's account number I 1 4-5--7 5 Vole 7 • /^ Location of property(if different from above) V O/n() Section Township Range Tax lot number 8320 Elkhorn Dr SE 3a et, Lyons OS' IE 084E32BDE Description of personal property Cabin on 17 acres Date of damage Cause of damage 9/7/2020 ❑Fire(attach fire department report) 4 Act of God (describe): Beachie Creek Fire Damage occurred to ►� Land -4 Building Personal property ❑Manufactured structure Describe damage Cabin destroyed.All trees killed. Application for proration of tax I am 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,and complete. X 01/02/2021 Applica is sig ature Date —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: 1.13-21 Clerk: /`r Date received: /-�5 GAJ V ( _ Damaged property: Clerk: J This year Land and improvements: Date rebuild complete: Months prorated: Real market value(RMV)before RMV after TO VA1-U ONLY fire/act of God: 3 1.4 �� fire/act of God: J' y 50 ADJURjus tai Assessed value(A before Value Destroyed ro INOA OST fire/act of God: c3C� percent of loss: i) Y P P � CHANGEThis year Personal property: Months prorated: -- RMV before RMV after fire/act of God: fire/act of God: AV before Value Amount of adjustment/refund: __. fire/act of God: percent of loss: Remarks: (2, / a+ Date property visited: ❑Damaged ❑Destroyed 150-310-083(Rev.12-15)