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RECEIVED <br /> Form OR-C-RHSA-2 FOR ASSESSOR'S USE ONLY <br /> Page 1 of 1,150-303-009 Datg�iggeiv�d� Zo� <br /> g Oregon Department of Revenue Approved Denied J h11V L <br /> (Rev.07-26-24) <br /> MARION COUNTY <br /> Date: By: ASSCSSOR <br /> Attestation for Continued Qualification of Rebuilt <br /> Homestead Special Assessment Currently Specially Assessed? Yes I No <br /> As provided byChapter <br /> p 94,Oregon Laws 2024(SB 1545) <br /> Comments <br /> Instructions: <br /> •Attestation forms must be filed with the county assessor. <br /> •Contact your county assessor with questions on how or when to file the attestation. <br /> •Additional information about this special assessment program can be found on Form OR-C-RI-ISA Instructions, 150-303-007-1. <br /> Filed with the MA(`( oil County Assessor for the tax year beginning July 1,20d 5 <br /> Part A—Description of homestead(please print crime) _— — — -- <br /> Fill in the boxes below to show the property you want to have specially assessed under the rebuilt homestead program. <br /> Property tax account number Map,tax lot,or parcel number Homestead situs(physical address) <br /> 910t�� �ggiki,902,$eL1 00 g3Us Emho-r"-' De5C <br /> Lyews eeR. 97�6-05 <br /> Part B—Written attestation <br /> SB 1545 Section 1 (9)states"Eligible property shall be assessed and taxed as other property similarly situated is assessed and taxed <br /> beginning with the property tax year that immediately succeeds the earliest of: <br /> (a) The date on which the rebuilt homestead is no longer occupied by the owner as a homestead, except when the owner is <br /> required to be absent by reason of health or active military service; <br /> (b) The date on which the rebuilt homestead is rented to another person for any duration;or <br /> (c) The date on which the rebuilt homestead is transferred to new ownership." <br /> SB 1545 Section 1 (7)(b)states"For each subsequent property tax year for which the specially assessed value is claimed,the owner <br /> of the rebuilt homestead must file an attestation, under penalties for false swearing,that the owner will continue to occupy the rebuilt <br /> homestead asthe owner's principa lling for the entirety of the property tax year." <br /> I(owner)I� r/YZ,14.. � /-ejr"' (please print)indicate bysignature I m Y 9 will <br /> 11 continue <br /> to occupy the rebuilt homestea my principal dwelling for the entirety of the property tax year.As owner of the above-described <br /> property, I acknowledge I understand the circumstances that may disqualify the property from special assessment and that I must <br /> file an attestation annually to continue the special assessment in the future. I declare under the penalties for false swearing[ORS <br /> 305.990(4)]that I have examined this document,and to the best of my knowledge, it is true,correct, and complete. <br /> Sign 0 Applicant signature <br /> here Date <br /> xed <br /> 0 /�3 i�d2S <br />