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Application for Proration of Property Taxes For county use only Due to Damage by Fire or Act of God Date received Oregon Revised Statutes(ORS)308.425 Instructions: •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 na e 11/1 it r/� 'W . Phone In,e.55 J . l� lit/ + / �//t SQ3-7y9-Zs// ar 5a3 - 732 Mailing address Email(optional) i51/ 33/.17 /1/ Fork g City State ZIP code L Ons GA ' 7351 Location and description of damaged or destroyed property Assessor's account number 1 13 $'o M t2- 3 S0 Location of property(if different from above) Section Township Range Tax lot number 53151 NYFrA gei toG v g 3 Oa-MO Description of personal property yap fax /d O 3 F,36,r_ GGO 700 ,____ Ijom � and barns p/ 5 lion-le/115 Date of damage 4/4.,./Q Cause of damage ' ❑Fire(attach fire department report) ($f Act of God (describe):(1QI 1 –r-r c_�i 1ia`/1 Damage occurred to CSLand 'Building 0 Personal property IgManufactured structure ea n,y ori Describe damage Ve1fiCIe5 , fillitticAclarej loot e �Jarns, /a`tlfeape- and 7i'rnber d//)arnea' fn Iv'(dfire , iacaafeof `7-7 ZO of rre A✓e/ 2. uhsure 1 6ttru1+ Jailer f hi'5 day ©r pixy-- d'qy . Application for proration of tax yam 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 dut®calc6te and finalize the tax proration. u o [l I1.1 '~ O co N Z W Declaration 0 a_ 0 2 111 w EE I declare under the pen Ities for false we ing [ORS 305.990(4)]that I have examined this document and to the best of mWowl68LJe Q it is true,corre t,and mplete. 2 x 9-/G -lo Applican si to Date —Applic t will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: Clerk: Date received: /0-/Ci_ .20 Clerk: 6 lt)//' Damaged property: This year Land and improvements: Real market value RMV)before RMV after 0 Date rebuild complete: Months prorated: fire/act of God: �C7[]p fire/act of God: Assessed value(AV)before Value ,�\ Amount of adjustment/refund: `s fire/act of God: .O.51:36I percent of loss: rV Destroyed property: This year Personal property: RMV before RMV after Months prorated: fire/act of God: fire/act of God: AV before Value Amount of adjustment/rafue ii- — 2Z6' fire/act of God: percent of loss: Remarks' Date' ArDate property visited: /U-/4( Damaged estroyed t h.t�` V\Ct, CL it J 150-310-083(Rev.12-15)