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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 MI ill 0-6-61/1 7r is PA+e;ci o" `f6 5?., 9 Mailing add ss Email(optional) taff 1Z31 kub y_ Wit: ,v&J City A 1lC-YN State ZIP code Ole d 730 ci Location and description of damaged or destroyed property Assessor's account number Mia. (e, if-424-5-57-09S+144—'41. 7 �;� f� 323rD 3c- ,2 7 0'' _ 3E abiab Location of property Of different from above) Section V1/,M. Township Range Tax lot number 0 C;.'9T3$Ai)t RAJ i 3 i oc Cs,a t-es Fr, I I rZd Ste, 27 715 R3E. GAre-5093E2,lodc,:;ic Description of personal property 0 &-4'TeS M/ if Rci.. GA TC,SrGr- 9.73 f 49 Pease 54rZ A•itAtk-kw411-kt t°ec. /Li'51- Date of damage Cause of damage �/ 441- p�.f-7-" ? ❑Fire(attach fire department report) LIGv/6 Act of God(describe): al----5 Damage occurred to WLand 1 Building .Personal property .t''vlanufactured structure Describe damage / (.$1765 CR. tj;fL- 'res — SAL Loss ti.vrev)Tti of to IN-.--4_,— A661-- d Rubble,-M-0N►e-/e444+/-/G �, iYrcund1 y�ch5- �Y s d�""m�`dSlAma -rt m�.L.CVyL� it LL (cxts 6u„„,zd a d Application for proration of tax I am 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 p rty is only d 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 th uty ttealct e� and finalize the tax proration. J CO CC I8 CO U fn 44 ZLLJ Declaration L I declare under the penalties for false swearing[ORS 305.990(4)]that I have examined this document and to the best CC.ny knowlegie it is true,correct, and complete. X o-�.. t y - A8 - ; 020 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: /0•/3-.20 Clerk: RV D(o Damaged property: This year Land and improvements: Date rebuild complete: —� Months prorated: �� Real market value(RMV)before RMV after fire/act of God: /0300 fire/act of God: 0 Assessed value(AV)before Value / �l Amount of adjustment/refund: --^' fire/act of God: 537 0 percent of loss: V Destroyed property: . This year Personal property: Months prorated: RMV before RMV after fire/act of God: fire/act of God: AV before Value Amount of adjustmenthedit4d: --55'34 fire/act of God: / percent of loss: Remarks: /t Date property visited: /016 'aO ❑Damaged ,6estroyed OD5Pm �`[L_ 150-310-083(Rev.12-15)