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Application for Proration of Property TaxesFor county use only Due to Damage by Fire or Act of God Date re°e"ed Oregon Revised Statutes(ORS)308.425 q-oZ'- 2_026 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 t;v..q e..v\e, c1e. A - D 5 303 38 l - 8o5(i Mailing address f Email(optional) 10 9 w C12 Vki tztitl PN e— PO Bl c /(17 'O3 e c o I v e•s e guka,b awl City State ZIP code GAl- E5e 11311 0E- °1734G Location and description of damaged or dc destroyed property Assessor's ac unt number _ (2 3 ees qSSc3 Location of pLo different from above) Section Township Range Tax lot number Description of personal property Date of damage Cause of damage pct _ g - 'a02..0 ❑Fire(attach fire department report) ❑Act of God(describe): Damage occurred to ❑Land tit/Building EcePersonal property 0 Manufactured structure Describe damage n0VAL eitS may�d aaor..2 tNt k-1.4 0,k1 pvcsovnAl ?roe-e t-AyC. side. 4,d c.-{ .1 -e----rb Ca-tAsieophic, wX1dcv¢.e.s; 54M te,..w, C_Any ovk. • Application for proration of tax [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 penalties 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 complete. xe�a�Q.. ~�a a. 5 C g - aa�' - 1 a.0 Applicant's si ture 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: [0/2.ei'110 20 Clerk: —t 7—. :frif Damaged property: This year Land and improvements. Date rebuild complete: �-- Monthsprorated: Real market value(RMV)¢€fore RMV after �0 P fire/act of God: 62/ fire/act of God: / Assessed value(AV)befpr Value 3 7 Amount of adjustment/refand: fire/act of God: b Li 010 percent of loss: Destroyed property: a` This year Personal property: Monthsprorated: �f RMV before RMV after 5, fire/act of God: fire/act of God: AV before Value • Amount of adjustment/reflood: —352.09 fire/act of God: percent of loss: Remarks: Date property visited: i0/1$/ZoZO 0 Damaged gpestroyed 150-310-083(Rev.12-151