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Request for Appraisal Review Office Use Only <br /> Log#: T' ( - 0 z <br /> Taxpayer please fill out this side only Date: /0/42021 <br /> Filing Deadline is the first Friday in December <br /> Taken by: iq <br /> Please use separate review sheets for each account <br /> Date: ipI'y)lti <br /> Have you appealed to the Board of Property Tax Appeals?: C Yes C No ' r <br /> Review Requested By(if different than property owner): I.,�0 py. A{ 1/ (r) I <br /> Owner Name: L; nae;, (kiln Email: ACJJYI, <br /> }tie ,/gkQb.c 1tsPhone: 50a.Op aQ9s <br /> Owner Mailing Address(complete address): ,.F- <br /> bla N c , Ju D1 1teS-) I..�bllrikf'� \1 <br /> Street Address of Property for Review: <br /> 612 'VI CtnSL(v1L eGT City: WIOr B[lf11 <br /> Map/TaxIot <br /> #: 041\J11,TJD005OD Account No.: L2066.3 <br /> Real Market Value <br /> {-�Requested: <br /> 'y`` <br /> `—' Structures: 1 v %0 Total: <br /> Land: / <br />- -- - - <br /> Please provide additional information and documentation supporting your <br /> requested value.Attach additional documents if necessary. <br /> CA( eCtr) 011 4;o G\0inIle AV <br /> Please email completed forms to: assessor@co.marlon.or.us <br /> You may also print and mail copies of completed forms to: <br /> Marion County Assessor <br /> P.O.Box 14500 <br /> Salem,OR 973090V THIS IS NOT AN APPEAL <br /> j ttjS01.“ Please refer to appeal rights included with your tax statement. <br /> To file an appeal please visit: <br /> M19I . . http://www.co.marion.or.us/CO/Pages/bopta.aspx <br />