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RECEIVED FEB 01 2021 Application for Proration of Property Taxescounty use only For Due to Damage byFire or Act of God Date received MARION Oregon Revised Statutes(ORS)308.425 Instruction ES SOR •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 Phone ELKHORN CORP 503.281.9676 Mailing address Email(optional) do Ann Phillips 2009 NE Brazee St Portland OR 97212 asphilli@easystreet.net City State ZIP code Portland OR 97212 Location and description of damaged or destroyed property Assessor's account number 540126 agd-6444-2-7- 1 4V1Z Location of property(if different from above) Section Township Range Tax lot number 34885 North Fork Rd Lyons OR 97358 31 08 4E 100 Description of personal property furniture, household goods, tools, mower,tractor Date of damage Cause of damage September 2020 0 Fire(attach fire department report) 0 Act of God(describe): Beachie Creek Fire/Santiam Canyon Damage occurred to 0 Land 0 Building 0 Personal property 0 Manufactured structure Describe damage three cabins destroyed, one horse barn destroyed, two cabins with smoke damage, three storage sheds destroyed significant damage to timber and acreage Application for proration of tax 0 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 aiy.A.,,...1..PLIkUly Tye‘ks'ure.a, EL1C116.) l/ Jan 26,2021 Applicant's signature J Date —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: 2-24{-21 Clerk: /'f Date received: 2- 2•-Z( Clerk:O 6 ,e;. Damaged property: This year Land and improvements: Date rebuild complete: Months proratedReal market value(glyi)y ey RMV after fire/act of God: /y 7`� fire/act of God: 72-740 �A vViEgecir:...1411-7,.. Assessed value(Al ifo ValueD t fatilosimeatfire/act of God: iL�1V1 � percent of loss: Destroy G IE 0 T Th•is year. Personal property: NO CAN�7t 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: Date property visited: 0 Damaged 0 Destroyed hAk tit„......, 150-310-083(Rev.12-15)