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RECEIVED <br /> ��++ p 1 t c A FOR ASSESSOR'S USE ONLY <br /> Form OR-C-RHSA-2 Date Receiv d <br /> APR U 1 2026 <br /> Page 1 of 1,150-303-009 Oregon Department of Revenue Approved Denied _ <br /> (Rev.07-26-24) <br /> Date: By: MARION COUNTY <br /> ASSLb5OR <br /> Attestation for Continued Qualification of Rebuif <br /> Homestead Special Assessment Currently Specially Assessed? Yes No <br /> As provided by Chapter 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-RHSA Instructions, 150-303-007-1. <br /> Filed with the Man D' County Assessor for the tax year beginning July 1, 20,a10 . <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 Map,tax lot,or parcel number Homestead situs(physical address) <br /> Opt,2 1 SUDDD3bcj ��bn 0 �-y �3S for <br /> �ou.cP,sL <br /> 33005� <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 tax year." <br /> I(owner) 2 I J4 I ( (please print) indicate by my signature I will continue <br /> to occupy the rebuilt home ead as 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 APPlicant sign ure Date <br /> here _024s, <br />