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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 /0/,/40� 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. Ai - plicant's name Phone b 117.Libito r�KS « 03 -.. .-.4%. Iling address Email(opti nal) ...., . .a 5(2(4411 tg5a74 ffee:slids gr/... os-ill Ci State P code &c- ZI fieS OP\ 2 5L0L6 Location and description of damaged or destroyed property Assessor's account number R149.-olio ---_.,tiz Location of property(if different from above) Section Township Range Tax lot number i Og 69 471 6: do Z a n escnption of personal property of d mage Cause of damage Date � ire(attach fire department report) ❑Act of God (describe): mage occurred to ❑Land ',Building ❑Personal property ❑ nption of pestructure �. Describe damage DSV^ 1,,,,,,e t , /Q )-2_,,..{,-.{,\,„( [2_(1.1 f Y lQ..�\& Ckackv A_ r_-Ck. .( w Application for proration of tax am applying to have the above property examined for proration of property taxes per ORS 308.425.Application must be submitted thin 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. X 01 ( ado" I 0) 61J-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: /(-Z 70 Clerk: ti Date received:/0..1/ _2(� Clerk: 4i Q 4, Damaged property: This year Land and imp ovements: Date rebuild complete: '�` Months prorated: `�` Real market value/3 6V)cefq� RMV after fire/act of God: Lf fire/act of God: 55�20 Assessed value(Pk_/ before Value Amount of adjustment/refund: fire/act of God: 90 1.22O percent of loss: O.3 8 2 Destroyed property: a This year Personal property: RMV before RMV after Months prorated: fire/act of God: fire/act of God: 307 ' 9 AV before Value Amount of adjustmen efund• � fire/act of God: percent of loss: Remarks: Date property visited:/t) :<'0 ❑Damaged /Destroyed ua (Al) ri 150-310-083(Rev.12-15)