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RFCFIVED <br /> Form OR-C-RHSA-2 FOR ASSESSOR'S USE ONLY <br /> Date Receiv d <br /> Page 1 of 1,150-303-009 Oregon Department of Revenue JAN Z 7 2025 <br /> (Rev.07-26-24) <br /> Approved Denied <br /> Date: By: MARION COUNTY <br /> Attestation for Continued Qualification of Rebuilt ASSE3WR <br /> Homestead Special Assessment Currently Specially Assessed? <br /> As provided by Chapter 94, Oregon Laws 2024(SB 1545) Yes No <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-RHSA Instructions, 150-303-007-1. <br /> Filed with the _Ma 1-I3TI - -- —County Assessor for the tax year beginning July 1,20 1.,5. <br /> Part A—Description of homestead(please print or type) __ — _ __ __. _ - <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 lllap)tax lot,or parcel number Homestead situs(physical address) <br /> ail/Alas(o \ '/ ‘C) q 69 a 6,7-) .7 A '8 v D qo '()_ S -1 -1 Se01-24 SC <br /> 1,LAo nC <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 as the owner's principal dwelling for the entirety of the property taxyear." <br /> I(owner) l�'19�Y1 C n'1Cl��1 1 G'/i/i r° 4 `�' 6 /a 41 <br /> ' (please rint)indicate by my signature I will continue <br /> to occupy the rebuilt homestead as my principal dwelling for the entirety of the property tax year.As owner of the above-described_property, I ac_knowledge_I understand-the-circumstances-that may-disqualify-the grope from special assessment and that 1 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 jAPPlicant signature(.4 � C � <br /> 7 <br /> here /l Date <br /> x �- ) � 01 /ZI/2 2 <br />