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RECEIVELL Application for Proration of Property Taxes For county use only Due to Damage by Fire or Act of God Date n 2 4 2021 Oregon Revised Statutes(ORS)308.425 Instructions: MARION COUNTY •Application for proration of property taxes may be made for the tax year of the property damage/destruction.If approved,this wedgMilamount 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'sname I�/ ��,/) r/ Phone 2sMaiD,2 'tJ ? 5-vi 85? 22.5.- Mailing ling address Emaji(optional) 22$8 ,/rNKJC S r dJ bur 1776e iv v',corn City StateZIP code Lycws oe 9735-s Location and description of damaged or destroyed property Assessor's account number ,- " 5 41073 0?2E 169 —10 -ot.5.00 Z4 c.:73 Location of property(if different from above) Section Township Range Tax lot number Description of personal property TOOLS rkf ere, 2 c i_Ass I e e4 R, f owLR Date of damage Cause o amage 0 9-D8-2020 krire(attach fire department report) di it of God(describe): u D ft&E Da�mav occurred to . �/� L� nd Ptuilding IBPersonal property ❑Manruffacctured structure Describe damage O uT BU/L 0/�G S 60(FJ D To r/4 LLy HIP/J31 N Z'/ Mill pl.vs C oV RED RV .SHitTEIZ- 29 X V2 , Application for proration of tax l 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. IF�C./ 11 4 � fJ�i_ 11414.4- 2 -/3 -202( Applicant's signature Date —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: 2.252.( Clerk:/ Date received: 0?,015-,,,2 t Clerk: Lv V 0 C, Damaged property: Its year Land and improvements: Real market value RMV)before RMV after Date rebuild complete: l fire/act of God: it22 8 70 fire/act of God: 3/2-G O AOS TSY ArOIL Assessed value(AV)before Value `RTnQv�ta�G40 nN�flhid: fire/act of God: 7-060C 1 percent of loss: 0 Destroyed properttlQ C This year Personal property: l� RMV beforeRMV after w r •d: < fire/act of God: fire/act of God: AV before Value Amount ofF� fire/act of God: percent of loss: Remarks: n Date property visited: ,.-e25-.2( Damaged 0 Destroyed bf (. 11-1 150-310-083(Rev.12-15)