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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 name Phone STEP 1EN D . # r11R-Ry E. CHENFV.c o- (5a3)33q-4( I 73 Mailing address Email(optional) 228 76 <TEN'N?E R b City State ZIP code 1.-yDNs OR 8735 Location and description of damaged or destroyed property Assessor's account number R4 I bCo 5 ----5q I O&S- Location of property(if different from above) Section Township Range Tax lot number SAME AS PfaDVE ISA 0 9S ,E 019o0 Description of personal property Tont_ 1.0S5 ,/wo(ls E 1 KD P,Mks t B�1O) (jks Date of darn age. Cause of damage 9 Sa0� Fire(attach fire department report) Act of God (describe): l,()1 Lb F(RE Dama occ rred to Land ` Building Personal property 0 Manufactured structure . describe damage Wit-6 SIRE bEs7Ro1(Eb /}LL PRDPERTy3 KOM5E)SHOP) ALL 4i,troino8iLEs VV)oT P J-fCLE t(RZE PERsOAJ4L PRoPERT?. Application for proration of tax !l I am applying to have the above property examined for proration of property taxes per ORS 308.425.ApplicationRost bq:Eilbri ed within 60 days of damage or June 30,whichever is later. W o Z Whether my property is damaged or destroyed will be determined by the County Assessor's office.If the assessor determines my erty i only r� 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 t i dutM calc aig 4.1 and finalize the tax proration. V cA Q W w Q Q Declaration I declare under the penalties for false swearing [ORS 305.99 (4)]that I have examined this document and to the best of my knowledge it is true,correct, complete. X J.S' 0 —PO r, Applicant's sig.-ture Dat 1 4 —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: 1-11-1/ Clerk:l Date received: /d. 13.20 Clerk: 06 ICJ i Damaged property: This year Land and improvements: Real market value efore^l RMV after Date rebuild complete: Months prorated: O��v fire/act of God: i� O'7 fire/act of God: /C 55'70 ivi E ,1kry 1 Assessed value(AV)before Value O e r gni men lg u fire/act of God: 139 f'� percent of loss: Destroyed property'( C1 A�G`E TO FFFF''►►MM�++"'""' This year Personal property: NO VNY, Months prorated: RMV before RMV after fire/act of God: fire/act of God: AV before Value Amount of adjustment/refund: fire/act of God: percent of loss: Remarks: Date property visited: /0•/b• oZ(,) 0 Damaged C Destroyed 05 F rn ULri ecf 150-310-083(Rev.12-15)