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• RECEIVED Application for Proration of Property Taxes For county use only Due to Damage by Fire or Act of God Date rSp1 2 2 2020 Oregon Revised Statutes(ORS)308.425 t/ Instructions: MARION COUNTY •Application for proration of property taxes may be made for the tax year of the property damage/destruction.If approved,thiNSAiQlount 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 Phone fi.riVA/ .TN ? :,zrq 5-03deli 053/ Mailiress Email(optional) • City State 3 z.24 4, N • Farely AD Sr lePg/�1rAc2.©Gi7,r�!coy eode LyoMv _ on 973si Location and description of damaged or destroyed property Assessor's accountccjnumbermb Location of 1(if diffe7t f/ 54'37/ m above) Section Township Range Tax lot number O c'I 3E 00 ,c3c_) Description of personal property Date of damage Cause of damage ZDZO Fire(attach fire department report) XAct of God(describe): 'C3r e .3.41 est-- Damage occurred to gLand 2CBuilding Personal property ❑Manufactured structure Describe damage II)1 * L 1J E VA-Tri b N ----- Application for proration of tax JZ(lam 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 penal ies 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 mplete. Applicant's s' nature Date 9 z Z- 7-0 Z.t) -Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: y-ZZ of Clerk: /if Date received: 10- 13- 2.4 Clerk: 'I#-Vo Damaged property: This year Land and improvements: Date rebuild complete: Months prorated: Real market value(RMV)before RMV after 1 ' fire/act of God: 40330) fire/act of God: 14 45 Assessed value(AV)before Value 5�l+ Amount of adjustment/refund: ^ fire/act of God: 2,92 b percent of loss: 0. Destroyed property: This year Personal property: Months prorated: q RMV before RMV after fire/act of God: fire/act of God: AV before Value Amount of adjustment/rehogoi: —I�f'J d a.O' fire/act of God: percent of loss: Remarks: Date property visited: 10-13i•2.0 0 Damaged 901Sestroyed 150-310-083(Rev.12-15) --- - i