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t � i • Board of Property Tax Appeals For official use only Petition number and date receive Real Property Petition for c. , f • County //� 1 //�}(� •Read all instructions carefully before completing this form. L 1 X028 •Please prim or type the requested information on both sides of this petition. •Complete one petition form for each account you're appealing. •Return your completed petitions)to the address shown on the back. •Use this form for manufactured structures,not the Personal Property Petition. •Include a copy of your tax statement. Petitioner(person In whose name petition Is filed) • I Check the box that appllec •.Owner. ] IT Person or business,other than owner,obligated to pay taxes(attach proof of obligation). 2 Name—Individ al,toryryermbn,or other business 3 Email address(option(( v.-etn- 5o- na l 'rC 4:46 R... Leo w.n_ 4 Phone number .f6S-9 3 / - Daytime j V3 -L-9 9.—.sem rl C l Evening 5 Mailing In,ma(street or PO box) aV xla�;. �nAtElsx f,g3" E -a.c. OW T Stale 8ZPcode r 9 Na ntacting S 3 tr` Pw lName of peon kp for(=Pen ion,LLC,or ones blueness 10 Title(for enemies President,rine president,tan reneger Sc.) -awn e ooh If a representative is named on line 11, all correspondence regarding this petition will be mailed or delivered to the representative. Representative Complete this section when the petition is signed by an authorized representative of petitioner.Only certain people qualify to act as an authorized representative.See the Instructions for a list of who giggles. 11 Name of mrxeenMlve 12 Email address(options() Z) c 'rk 13 Phone number {� r?1 •eynna !Evening n 14 Malang wick as(street or PO Box) 15 City 16 Stele 17 ZIP code 10 Relationship to petitioner roma on line 2 - -� 18 Oregon stale bar number 20 Oregon appraiser license number 21 Oregon broker license number 22 Oregon CPA or PA permit or SEA mamba My refund resulting from this appeal will be made payable to the petitioner named on line 2 unless separate written authorization is made to the county tax collector.However;if a representative Is designated,any refund will be sent to this individual or business,not the petitioner. • Attendance at hearing • m We you or your designated representative attend the hearing? 'Yin L No path an el dkd ✓tot ape.441 If you choose not to be present at the hearing,BOPTA will make a decision based on the written evidence you submit. Property Information 24 Assessor's account number(foo your tax statement) 25 Assessor map end tax lot number Irmo your tax etatemenb t5bCk 26 sees address and city Mira properly le located 27 Property type RI_'esidential LJ Commercial Penn 4 9teu S_ ...� s � lecA C y, fd6hVphre rMulti_family nPorest rhMustrial 15031ee6.1(Rex os-In Please turn over—form continues on back��