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Application for Proration of Property Taxes For county use only Due to Damage by Fire or Act of God oeterece�"ed Oregon Revised Statutes(ORS)308.425 -2C. 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 R42097 r-S 41 Location of property(if different from above) Section Township Range Tax lot number -Vit: 4C t -e,\0 C,I„ Q c\ 0,_ C Description of personal property tx A roc-E-- D/L I (f Date of damage Cause of damage Sept 2020 0 Fire(attach fire department report) OO Act of God(describe): Lionshead Wildfire Damage occurred to ID Land I]Building B]Personal property El 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 El 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 br 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 — for 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-(b-II Clerk: Cr Date received: 03/11/2021 Clerk: ZJ #4 Damaged property: This year Land and Improvements: - Months prorat Real market value(13M\/).before RMV after Date rebuild complete: fire/act of God: 1,648,210 fire/act of God: 3,010,860 A�� TMe TO YM. Assessed value(A before Value VAT fire/act of God: 1 792 350 percent of loss: 0 Destroyed prope�y;n CHPNGG `v This year Personal property: �V V RMV before RMV after Months prorated: 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 ®Destroyed 150-310-053(Rev.12-15)