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Request for Appraisal Review Office Use Only <br /> Log B: i7/ 053G <br /> Taxpayer please fill out this side only <br /> Date: /277.1-2- <br /> Filing <br /> /7.-/2Filing Deadline is the first Friday in December Taken by: !1 <br /> Please use separate review sheets for each account <br /> res e99 <br /> Date: I2-/ ywl <br /> Have you appealed to the Board of Property Tax Appeals?: C Yes (,kNo � <br /> furt`t, <br /> Review Requested By(if different than property owner): <br /> ` 3113 <br /> Owner Name: �C�\i X erg Email: sl^alf�C¢. +k (Q�ICI I )— Phone: 2., <br /> gMc,I.«41 <br /> Owner Mailing Address(complete address): <br /> /2—CC APcACV e 7i . (% ± 10 0 <br /> Street Address of Propertyfor Review: ly SC10/14' City: /Vi°/tr[7[7//� <br /> Map/faxlot#: �%IN 3 SA(L`Cud Account No• <br /> C)15' uftl <br /> Real Market Value Requested: <br /> Land: Structures: ,i;341; 1 13 7 Total: 43 % 1 1 3 ti 0 <br /> Please provide additional information and documentation supporting your requested value.Attach additional documents if necessary. <br /> 111r� Cc*&r ratdec*s 1/41 hie Or U11if( 6ov773) grid <br /> arty (c,001'116) �"lt�' "�v �rChats e frit, i361f341/ <br /> 5giseietrie i.;/74,224.7[ <br /> Please email completed forms to: assessor@co.marion.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 97309 <br /> THIS IS NOT AN APPEAL <br /> Please refer to appeal rights included with your tax statement. <br /> To file an appeal please visit: <br /> http://www.co.marion.or.us/CO/Pages/bopta.aspx <br />