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,.. . Application for Proration of Property Taxes 'RECIEVEDly Due to Damage by Fire or Act of God Date reeved Oregon Revised Statutes(ORS)308.425 SEP 212020 Instructions: •Application for proration of property taxes may be made for the tax year of the property damage/destruction.If approved,ttMAN,twilecephaFnount 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, h�c�everCsllr. •File your application with the county tax collector of the county in which your damaged property is located. Applicant's name Phone Sack b. a, CLeLLc, I. tia C... 503-ciSi-(08 C)F Mailing address Email(optional) 40Gi Naves St 342 c .a n 2e ,c..ew, City State ZIP code Ne,voberg OR (} l32 Location and description of damaged or destroyed property Assessor's account number K4*050 S470s-o lSRt4 09 3E 00 3o0 Location of property Of different from above) Section ,34 Township Range Tax lot number 11002, Dace Ln. \E Lott a,ucb Lyort5 053'Et&AA6°laa t� 1 Description of personal property LJOnvv --, r�'',CYe` V O� I, , 34 ^tc'rCHouse ose ("2-Story) wCll \i‘oc .Seg S'-O:i.,r5410 P vCr Date of damage Cause of damage {p4c0-Fo ` a-t +rives i 918 12o 20 0 Fire(attach fire department report) ®Act of God(describe): D Ga-C:hi e C-rpe_L trv-t Id 9;re, Damage occurred to acLand IR Building JffiPersonal property 0 Manufactured structure Describe damage + ed^ 'Nita, v,A7wg- 1&-ou�e 15 a tkie ack e-LOoko la-, Ike- wcVh stied b•a-s 0 e y o.h1d t;tn.s ujoul bust tk,¢. 'ront w a S c1Qrn s1u.d , 1 RO- .st-ep S -t-o.-i'C.e rtxren, ctrv- ctJ►so a100.e ss t-ubble.) tfn.a. IN laN rw` out' wwtn Locto d cum-4%e -Mg- prop \s ba-5icalt r'ubb;Sh ah14. PAAA,, ' lot, itchti►.t \k. Application for proration of tax ®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. W E 0 Declaration 7 — Uco CO I declare under the penalties for false swearing[ORS 305.990(4)]that I have examined this document and to the best of 0kno0ov ed t Fri it is true,co —*nd corn d tete. ` a g LLI w x I Applicant's sie at Date // ' -� Ohio " 9 / 15 I . o�. - —Applicant will be notified ot�.►I✓he county's decision— For tax collector's use only For assessor's use only Date received: 4'2,1,14 Clerk: /41.- Damaged Date received: �0-14, 2.0 Clerk: IN V 4#0(.0g property: This year Land and improvements: Date rebuild complete: Months prorated: Real market value(RMV)before RMV after I�Q� fire/act of God: l fire/act of God: CiCO Assessed value(AV)before __„ Value Amount of adjustment/refund: fire/act of God:0l,Qa.Z jQ percent of loss: 6 . 4 11- Destroyed property: This year Personal property: Months prorated: / RMV before RMV after p fire/act of God: fire/act of God: /�yi' AV before Value Amount of adjustment/nfwtd b fire/act of God: percent of loss: Remark • n Date property visited:IA-)`i• 20 0 Damaged 2stroyed V`Url (eta ai¢/t( tc� 150-310-083(Rev.12-15)