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CLACKAMAS COUNTY ASSESSOR AND TAX COLLECTOR <br /> STATEMENT OF ADVANCE TAXES ON MANUFACTURED STRUCTURES <br /> ORS 308.865&311.465 <br /> PRE-PAY ESTIMATE YEAR 2019-2020 <br /> DATE: �Js� �(:)\ INITIALS: <br /> ACCT# 1'( HOME ID# O X# <br /> REQUESTED BY C/k :f ) l t. \C O PHONE# C1 r • � . kei <br /> TAX ESTIMATE: PRIOR TAXES OWING? DYES $ TO DATE <br /> 'NO DATE PAID 9 ❑ PSNL CK Gases <br /> Senior Deferral ? Yes ❑ Nol,Date pd. Vets E ? Ye ❑ Nod <br /> 2018-19 LEVIED TAX e <br /> State Dwelling fee(IF APPLICABLE) 0° MOVE OUT OF COUNTY ❑ <br /> TOTAL �" 1 RE-ACTIVATE EXEMPT HOME ❑ <br /> X5% Estimated-TAX DUEAPPRAISAL CALCULATION OF ASSESSED <br /> VALUE <br /> LOIS TAX BLOCK RELEASED ❑ TAX RATE <br /> REFUND INFORMATION: <br /> NAME: PHONE#: <br /> MAILING ADDRESS: <br /> ��pp FOR TAX DEPARTMENT ONLY l <br /> PAID BY: 426-0,2',70 Pl fe(,{x. PHONE#: QV-6�j�''j?` <br /> MAILING ADDRESS: /, /r V�i� � L1( wvii '7 t15 <br /> CASHIER: AC OUNTING: <br /> DATE PAID 61.Q0170 SEND STATEMENT <br /> 1SICASH L3 a 5Q 0 NO REFUND PD IN FULL <br /> ❑ CERT FUNDS 0 SEND REFUND <br /> ❑BUSINESS CK DATE <br /> 0 PERSONAL CK <br /> CHANGE G n <br /> ADVANCE TAX PAID: SPLIT CHECK TOTAL <br />