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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 Phone in.�$.5aj5 . it r/r` /P1)2/II 503--7‘19--25// err 563- 73.2 Mailing address Email(optional) 151/ "-- 33/i7 A/ f Ork igd City StateZIP code L47 0 }A 5 di< 9 735? Location and description of damaged or destroyed property Assessor's account number el0 /65 'i -•((-0\cam Location of property(if different from above) Section Township Range Tax lot number 13/ 51 iU FPri 3 6. c 0e, at ey.)—t Description of personal property /MP /4)C hof 0 3-3 ,3�C OG6 700 AolA IL. ft ft t1 earn plc. tion eljhh Date of damage vi 20 Cause of damage ❑Fire(attach fire department report) Act of God (describe): ��) 1d ,$1 ialV- Damage occurred to Ca ie y or gLand 't Building 0 Personal property -Manufactured structure Describe damage VehielI5, s4K4--�ac41r((.eI nom e / Barns, landscape, ante? I inner 'i//)urned In iui(d fi re i' //tca zf e&l cf_7 Z o o f r'r.e j ' / 2. tin Pir€- i , ka-r4+- /e 't'r lin.5 day or- /7 K/- a',i . 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®calc t6te and finalize the tax proration. > o if ,-4 OU tib Z LII Declaration 0 CL 0 v 111 w E < I declare under the pen !ties for false we. ing [ORS 305.990(4)]that I have examined this document and to the best of myfowl68ije Q it is true,corre t,and mplete. x ,� i • �' 7. 1C -2l) Applican s 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: /0-1(1.,20 Clerk: 2Ob we Damaged property: This year Land and improvements: "'� Real market value(R before RMV after /O �n Date rebuild complete: Months prorated: fire/act of God: // 1O6 fire/act of God: o2F 2 �_� Assessed value(AV)before Value Jj•114253Amount of adjustment/refund: fire/act of God: ")1'2 too percent of loss: (J Destroyed property: This year Personal property: RMV before RMV after Months prorated: q fire/act of God: fire/act of God: _ 311'3 j AV before Value Amount of ad'ustment/refapel: fire/act of God: percent of loss: Remarks: r /� Date property visited: /0•j'/-a0 0 Damaged stroyed Ve4L11FYI via ALiteIc.('�U c9 150-310-083(Rev.12-15)