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RECEIVED SEP 17 2020 Application for Proration of Property Taxes For county use only Due to Damage by Fire or Act of God Date received MARION Oregon Revised Statutes(ORS)308.425 Instructions: TAX COLLECTOR •Application for proration of property taxes may be made for the tax year of the property damage/destruction.If approved,this may reduce the amount of tax due or result in a tax refund.The tax year is from July 1 to June 30. •Your application must be filed within 60 days of the damage or by June 30 of the tax year in which the damage occurred,whichever is later. •File your application with the county tax collector of the county in which your damaged property is located. Applicant's name i�/ I Phone 1�cu ii_e 41 /folk l ee >� 7)71,:67t_S'a3 '-,SS/-ca/.� Mai in ad ess� Email(optional) Y 0 1JCSy a5'�� K.r1t11\ miI y 'o02@�(4c{, City State "IP code I i c n,., 1_ 0 n s 0 97t35Y Location and description of damaged or destroyed property Assesso' account number r� ` ©S�`� 5-4pg- Ij $"4031 Location of property(if different from above) ,- Section Township Range Tax lot number 1d. 1L( ()3ccnnprc\ 08 09 6" 01 • , Description of personal property , ,r rti -.f ; I / cites b� 5 vL\ lJcLui 1,'4-e bast-n-2,04 �147�� 5�1�P/ Date ofd age Cause of damage ,, ,, 11 i��/ CI � I a o ❑Fire(attach fire department report) Act of God(describe): W/YI /j'02e (&ec4,'e e✓kI Damage occurred to gland I IBuilding XPersonal property_ ❑Manufactured structure � ) Describe damage Uue toe re_ �tLuLe-sice__/� IL GO/0 / g_z thz-if -SW 1[/,,I'd LAI k- C V\v`Va)1 C7n 1 c to o r ` -e vet _k(a. (---ed al- /_ 3 U or)-1 %/s/-2c) - ?ref ae-- (AAS c/ -0-(a I O5S CLa t-,),GC0 nqS W-Cre rI2G le, bc,/ �isize • Application for proration of tax 4 I am applying to have the above property examined for proration of property taxes per ORS 308.425.Application must be submitted within 60 days of damage or June 30,whichever is later. Whether my property is damaged or destroyed will be determined by the County Assessor's office.If the assessor determines my property is only dam- aged,I must notify the tax collector of the date that the damage is repaired.Such notice will serve to inform the tax collector of their duty to calculate and finalize the tax proration. Declaration I declare under the penalties for false swearing [ORS 305.990(4)]that I have examined this document and to the best of my knowledge it is true,correct, and complete. �� 61//b2) -20 A Applica s signature Date —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: q_11_20 Clerk: fji Date received: IQ-fpr 2.0 Clerk: No y1) Damaged property: This year Land and improvements: Date rebuild complete: ---- Months prorated: Real market value(RM before RMV after t fire/act of God: ,Z5-I I—I0 fire/act of God: `15 a v.) Assessed value(AV)before Valuew�.��` Amount of adjustment/refund: '' fire/act of God: 1°10.& percent of loss: 0 Ti(ditO Destroyed property: CrThis year Personal property: Months prorated: / RMV before RMV after fire/act of God: fire/act of God: I AV before Value Amount of adjustment/rektnd: — 1 ytti,32 fire/act of God: percent of loss: Remarks: Date property visited:J,(jJ-2.0 ❑Damaged,,la6estroyed C5 121W 0,10Y6)frktIS 150-310-083(Rev.12-15)