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s , Application for Proration of Property Taxes For coun use only Due to Damage by Fire or Act of God Date receved Oregon Revised Statutes(ORS)308.425 i --?(.. )-2b2 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 _ Phone hi; ' A eL •o iu e -S-01R q9"/ - 4 Sg Mailing address Email(optional) 4X .5/6 rndok,A,c ySi 2t OR,yes c�' I I t�1 State ZIP o e 1 / ofQ �-)3,gU Location and description of damaged or destroyed property Assessor's account number R41436 / 541436 Location of prope.ty(if different from above) Section Township Range Tax lot number 32385 North Fork Rd Se 11 BA 09S 3E 200 Description of personal property Lyons, OR 97358 Date of damage Cause or dx;' // 1_) . a�Q $Fire(attac fiindpt m�rept5r j *Act of God(describe): . Ise;_ . 'i r S Ihr , _ Damage occurred to Land r Building personal property O Manufactured structure Describe damage fftAL 1.- SS --1-6 -F,-,r..e., Application for proration of tax 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 o r,.,- - f X . ..�t.A1.Al� As a Ii•_,y /o .20 2s,20 App' s signature 0 Date —Applicant will be notified,of the county's decision— For tax collector's use only For assessor's use'z WV only1_ Date received: -3.til Clerk: ' L)Date received: i 1, � 0 • Cleric v p 0 Damaged property: This year Land and improvements: Date rebuild complete: Months pro -- Reel market value(RMV)b fore RMV after luggrTp VA- g nre/act of God: +.� � ! fire/act of God: 2Q Io q a ADJl ]T Assessed value(A before Value d Milryv or fire/act of God: 112..5n-C� percent of bas Destroyed pro CHANU This year Personal property: Months prorated: RMV before RMV after fire/act of God: tire/act of God: AV before Value Amount of adjustment/refund: ------ fire/act of God: percent of loss: Remarks: Date property visited: kL'11'7n 0 Damaged_'bestroyed D rr‘Ld aor4-lole ('o 470614 reAPIA111,0 rid' liL T9 j - - 10-0Bs(ReV.12-15) L 'd NH .(1 wd9 L : [ EE '06 'Po