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E- irsY 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 (,_ Z 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 Breitenbush Hot Springs Retreat& Conference Center 530-305-6402 Mailing address Email(optional) PO Box 245 FD@Breitenbush.com City State ZIP code Idanha OR 97350 Location and description of damaged or destroyed property Assessor's account number R42098 & t• �y Ctr> Location of property(if different from above) Section Township Range Tax lot number l,` CC– i+CIA t)l i S�i fic4 Description of personal property Date of damage Cause of damage Lionshead Wildfire Sept 2020 El Fire(attach fire department report) 0 Act of God(describe): Damage occurred to 0 Land 0 Building x❑Personal property 0 Manufactured structure Describe damage Lionshead Fire move through our property devastating both the built environment as well as the trees/land 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 fur Breitenbush Hot Springs 03/11/2021 App nt'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: 3-(6-2/ Clerk: ry Date received: 03.11.2021 Clerk: ZJ#4 Damaged property: This year Land and improv,ements: Real market value IRNA be oJg, RMV after Date rebuild complete: Mo tthhs�grpt@y_ fire/act of God: 1.991.810 fire/act of God: ,991,810 AD ��Q'(MEg�NTy 1 VP, -� Assessed value(A b ore Value �741fidunt g(�irplrw9l�t irAWILfire/act of God: 65,460 percent of loss: 0 Destroyed propto``HANG 1�J This year Personal property: 1`1� 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: 03.11.2021 0 Damaged 0 Destroyed Al! improvements are intact per Jon Hass of Breitenbush Hot Springs. No change. 150-310-083(Rev.12-15)