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f1►31851 507( Coepmt- Cr,eaL.e NEL 50 <br /> i-/,,,,1 i T f <br /> ///e,a <br /> ,7// <br /> Application for Reassessment of <br /> Destroyed or Damaged Property <br /> As provided by Oregon Revised Statutes(ORS)308.146(6) <br /> Instructions: <br /> •Application for reassessment can only be made for property that was destroyed or damaged on or after January 1 and on or before <br /> July 1 of the assessment year. <br /> •This application changes the assessment date for your property to July 1 for this year only.If you plan to make major improvements <br /> to your property before July 1,you may want to keep your assessment date on January 1. <br /> •File this application with the assessor of the county in which your destroyed or damaged property is located. <br /> •if filed within 60 days of the damage or by August 1,whichever is later,there is no late filing fee.Later filing is allowed if filed by <br /> December 31 of the current assessment year and accompanied by a late filing fee. <br /> Filed with the /21 i-< 0 N County assessor for the assessment year starting January 1, . <br /> Appicant's name Phone <br /> Mailing address Email(optional) <br /> 52 76, G';`i1t.) <') r 7 ,V/ CpJ 7i'C e Genet <br /> ity <br /> code <br /> C <br /> State ZIP��3 Description and location of property <br /> Assessor's account number(as shown on your county property tax statement) Township Range Section Tax lot number <br /> M131857 06 2W 31D 01100 <br /> Address of property(if different from above) Description of taxable personal property <br /> 5076 Copper Creek Lp NE #50 Manufactered Structure <br /> Salem OR 97305 <br /> 1. The property described above was destroyed or damaged on .:•14.7—/, by ,Fire* 0 Other <br /> 'For property destroyed or damaged by fire,include a copy of the fire department's report. <br /> 2. The destruction or damage occurred to: 0 Land 0 Building 0 Manufactured structure 0 Personal property <br /> 3. Describe the destruction or damage: - A /j� A 1 <br /> fC;!.� of r CIS{/GO C�j/J�.C.�i� <br /> If you file later than 60 days after the damage or destruction date or after August 1,whichever is later,and by December 31,you'll need to <br /> pay a late filing fee.The fee is the greater of$200 or 1/10 of 1 percent of the real market value of the property as of the last assessment date. <br /> Late fling fee is attached: 0 Yes 0 No <br /> Declaration <br /> I declare under the penalties for false swearing[ORS 305.990(4)J that I have examined this document and to the best of my knowledge <br /> it's true,correct,and complete. <br /> Applicant's signature Date <br /> For assessor's use only <br /> Date received: Clerk: <br /> January 1 real market value: July 1 real market value: <br /> Land: Land: <br /> Improvement: Improvement: <br /> Manufactured structure: .. I b7�-o Manufactured structure: <br /> Personal property: Personal property: <br /> Total: 3 7 d;--3 Total: "7/ <br /> Remarks: pZ ri) y j)9 <br /> 150-310.084(Rev.12-15) <br />