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Clear Form 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 lei - tax collector of the county in which your damaged property is located. App arrts namlen / 1i t , Pe rK1 O S - ssq -2 -/ -1 Mailing addrggs 1301 �� Email(optional) City i_y ./ v S/ f!" ZIPf7 58,0_5 and description of damaged or destroyed property`" Assessor's account number 0893 sCc):9� Location of property(if different from above) Section Township R e Tax lot number �, ,_ 1 DI Pct( S IF 0J5P,C2d3 oD Description of•ersonal property Lyvi-/S Date mage 20 Cause of damage '� 0 Fire(attach fire department report) Act of God(describe): plcoccu d to nd ilding ligrreperty 0 Manufactured structure Describe damage io+cL1 LoSs W C4 Z / Application for proration of tax 111 w I am applying to have the above property examined for proration of property taxes per ORS 308.425.Application be submitted in 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 RS 305.990(4)]that I have examined this document and to the best of my knowledge it is true,correct complete. q �I�` x A4._.----17, `-tom -2.0 Applicant'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: Clerk: Date received: 10- %3. 24.) Clerk: 4*-b(o c.A V Damaged property: This year Land and improvements: i-- _ Real market value(aAV)before RMV after Date rebuild complete: Months prorated: fire/act of God:3'1 6.8ZO fire/act of God: 12L000 Assessed value(A before Value 12 Amount of adjustment/refund: fire/act of God: 21 8 2-0 percent of loss: d 14.3Z-.. �JZ-- Destroyed property: This year Personal property: 9 RMV before RMV after Months prorated: fire/act of God: fire/act of God: AV before Value Amount of adjustment/rafdnd: — 8-2 I'35 fire/act of God: percent of loss: Remarks: Date property visited: 10-s 3-2 0 0 Damaged stroyed o6Pm cf 150-310-083(Rev.12-15)