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• For official use onlyForm OR-B-RPP Petition member and date received Page 1 of 2,150-310-063 (Rev.12-02-20) (eager Department of Revenue Oregon Board of Property Tax Appeals Real Property Petition for Marion County 22-016 •Read au instructions carefully before completing this lone. •Please prat or type the requested Information on both sides of this petition. •Complete one petition form for each account you're appealing. •Return your completed petition(s)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 sled) 1 warer ban tat apogee: plc ante.. °Peon or business,other than owner.obligated to pay taxes(attach proof of°blgeda 1. 2 IYme—kdidrhi corporation.or other business a Enna address@Sense Michelle Tyler micheueatylerlife.us a Na antm. 503-307-6145 4 Phone number "- !Evening 503-307-6145 c- C-3 h a 1 s Mrergaaa..tared oroom4 c� 1'I 915 N Douglas Sto� T' ems/ 7 State m B ZIP code IOR 97013 — Canby I0 nee gr example.preddw*vim Far �rn,tax mIHgr,MO business�IB Ns.aar.m uahgm corporator;ua mann bavwsa - r If a reprmentative is named on One 11,al correspondence regarding this petition wig be mailed or delivered to the representative. I Complete this seed°"when the pagtion is signed tri an aithwzed representative of petitioner.OMy certain Representative 1 people quaVy to act as an aut prized representative.See the instrnwtions fora 1st of who qudiflos. 11 Name cifrrrmrt+ive 112 Ernst address(optional, 13 Rime number Daytime I Ewing 14 Alain;address(street or PO Box) 13°M r stet, ilwade 10 RMCbdb to potions,named on in 2 19 Oregon Cale bar mmbr 120 Or.00nwwale•r Ica*exalter 1M Oeam broker license Pian 122 orogen CFA or PA Perms urSEA.number Any refund resulting horn this appeal will be made payable to the petitioner named on rale 2 unless separatevedten authorization is made to the cotgtytax collector.However,it a representative is designated,any refund will be send to this individual or business,not the petitioner. Attendance at hearing vs WMyou or your designated representative arced the hexing? IEYes ONo ff 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 escort number @u your mu nmemrnl 25 Assessor map ad tax lot number(worn your tax statement) 360623 031W33CB12700 26 sheet address ed city where property is located 22 e'romhrytm. 0Resid.dal ° n Cahh.hial °Farm 11586 Grouse In NE Aurora,OR 97002 I jMld structure °Muer-famiy ()Forest 0IndusHmal