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/ - . 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)308.425k D-lc- €C'JL� 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'i4Q ` Q�� °37V!"Y' - � /i71� 1�! 1 .t/C�1 1C� 1 Yl1S S Phone -5- (�- . Mailing address ,r I 6-63 til 00 22 tot g r Sowt-t-I`A.W1 Rwie, I , ,, . ` i, Email(optional)e(`b�`(�Y �� t arr City ' s✓b Q4Nd l�Garf1 Lti ,� State ZIP code v t_.� c2 358 Location and description of damaged or destroyed property , Assessor's account number -j 5 Si-gild 0 g3 (2-q ►DB Location of property(if different from above) Section Township Range Tax lot number 184' cc( 2G 0O2-106 Description of personal property �i Date of damage Cause damage; �LNr � I i (;,v'e� fj ,'\ 7` • be t'Z3 ZbZd ire(attaciT ire department report) ❑Act1(o/ff od� (describe): Dana a occurred to�y �� - -- 'Land IB(3uilding [!d•Personal property 0 Manufactured structure Describe damage , a� Ula d k.:0, ('jam 71 a. e 4.D vl p cApr a �� w��9 0 � e) / I , 9 , et- 0 0a,\P 1/1 LO eNe- cool l R, 1 ' O ) yeA);49,rj� � Application for proration of tax 'idam 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. I • Declaration I declare unde e pen. '-- or false swearing[ORS 305.990(4)]that I have examined this document and to the best of my knowledge A tru:. cor :•t, . d c• 1.l' e. 41 I ' ' V." I /L� Zv Ap•Ican'sgnature W Date — ' licant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: 1 i-17-jQ Clerk: /� received: 11, i p. 2v Cleric v 0 Co Date Damaged property: -. This year Land and improvements: Date rebuild complete: Months prorated: Real market value RM 1)bgf RMV after fire/act of God: y DOI fire/act of God: ( 2350 0 Assessed value(>0 tpfore Value Amount of adjustment/refund: --- fire/act of God: ,0 to percent of loss: 0.-1 Q 54 Destroyed property: This year Personal property: Months prorated: q RMV before RMV after fire/act of God: fire/act of God: AV before Value Amount of adJustmen'refund. 2.137`3/ fire/act of God: percent of loss: Remarks: • Date property visited: 1�• � �U 0Damaged oC_ _�.,f OA I Ile �estroyed �v 150-310-083(Rev 12-15) • 1