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Board of Property Tax Appeals For official use only <br /> Petition number and date received <br /> Real Property Petition <br /> for MARION County 20-030 <br /> •Read all instructions carefully before completing this form. <br /> •Please print or type the requested information on both sides of this petition. <br /> •Complete one petition form for each account you're appealing. <br /> •Return your completed petition(s)to the address shown on the back. <br /> •Use this form for manufactured structures,not the Personal Property Petition. <br /> •include a copy of your tax statement. <br /> Petitioner(person in whose name petition is filed) <br /> 1 Check the box that applies: *Owner. <br /> I—Person or business,other than owner,obligated to pay taxes(attach proof of obligation). <br /> 2 Name—individual,corporation,or other business 3 Email address(optional) <br /> • Ivan Silbernagel <br /> 4 Phone number <br /> Daytime 503-378-0611 I Evenkg 503-378-0611 <br /> 5 Mailing address(sheet or PO Box) <br /> 5826 Shaw Hwy SE <br /> 6 City 7 State 8 ZIP code <br /> Aumsville OR 97325 <br /> For 9 Name of person acting for corporation.LLC,or other business 10 Title(for example,president,vice president,tax manager,etc.) <br /> buskrsss <br /> use only <br /> If a representative is named on line 11,all correspondence regarding this petition will be mailed or delivered to the representative. <br /> Representative Complete this section when the petition is signed by an authorized representative of petitioner.Only certain <br /> } people qualify to act as an authorized representative.See the instructions for a list of who qualifies. <br /> 11 Name of representative 12 Email address(optional) <br /> 13 Phone number <br /> Gaye _ (Evening <br /> 14 Wog addreeditreet or PO Soup <br /> 15 Y ON <br /> 16 State 17 ZIP code <br /> V ry <br /> 18( etiarehip • : named on line 2 <br /> Cr <br /> 19 Oregon statear <br /> number • 20 Oregon appraiser license number 21 Oregon broker license number 22 Oregon CPA or PA permit or S.E.A.number <br /> Any refund resulting from this appeal will be made payable to the petitioner named on line 2 unless separate written authorization is made to <br /> the county tax collector.However,if a representative is designated,any refund will be sent to this individual or business,not the petitioner. <br /> Attendance at hearing23 <br /> t� <br /> Will you or your designated representative attend the hearing? tt Yes C No <br /> If you choose not to be present at the hearing,BOPTA will make a decision based on the written evidence you submit. <br /> Property information <br /> 24 Assessor's account number(from your tax statement) 25 Assessor's map and tax lot number(from your tax statement) <br /> R28290 081 W 18 01000 <br /> is located 27 Prosy type dential Commerciallit Farm <br /> 26 Street address and city where property i n <br /> 10173 Keene LN SE, Aumsville ❑Mfd structure n Multi-fam ly n Forest r Industrial <br /> 150-310-083(Rev.05.17) Please turn over—form continues on back�♦ <br />