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r. Application for Proration of Property Taxes For county use only Due to Damage by Fire or Act of God °a181Bee'ved 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 Michael Patterson&Tonilyn Cole 360-931-4190 Mailing address Email(optional) 1918 SE 40th Ave mikpatty@yahoo.com City State ZIP code Portland OR 97214 Location and description of damaged or destroyed property Assessor's account number -� 541231 ILL{ l Z�l Location of property(if different from above) Section Township Range Tax lot number 25642 Dewitt Ln SE SEC22 T95 R2E 092e22d001 Lyons,OR 97358 Description of personal property Home and furnishings Date of damage Cause of damage 9/8/2020 O Fire(attach fire department report) Act of God(describe):Reocite CC'r?R-k,ataz-arRli fYn't'1A(� Damage occurred to J 0 Land El Building 0 Personal property 0 Manufactured structure Describe damage Beachie Creek/Santiam Canyon fire burned the entire residence to the ground.Additional damage to auxiliary structures and trees on the property. May also affect future river access. W N Z cc � Application for proration of tax > `� O 0 m U fn El I am applying to have the above property examined for proration of property taxes per ORS 308.425.Application must btlubmeltd z 163 within 60 days of damage or June 30,whichever is later. o_. O CD Whether my property is damaged or destroyed will be determined by the County Assessor's office.If the assessor determines my prope�"only1- Q 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 ddulto calculate 5 and finalize the tax proration. Declaration I declare under the penalties for false swearing[ORS 305.990(4)]that I have examined this document and to the best of my knowledge it is true, •rrect,and complete. Xq/l 7/2-02-(-)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:Damaged property: Date received:and a'Improvements: Clerk: 0 r7�� This year Land and Improvements: ` Date rebuild complete: Months prorated: fire/aReal ct of Go fire/act of God: /01 ue(RMV)before RMV after ✓ _ y�8abo Assessed value Amount of adjustment/refund: fire/act of God: before_4, LIO Vpercent of loss: d �� Destroyed property: 01 1 This year Personal property: Months RMV before RMV after prorated: fire/act of God: fire/act of God: AV Amount of adjustment/1td: —' 0 1'6O fire/aefct of God: Value�ijpercent of loss: Remarks: Date property visited: 11)0 O 0 Damaged XrIcestroyed ow-p1 v�rrtied 150-310-083(Rev.12-15)