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-**21 , Application for Proration of Property Taxes For county use only Due to Damage by Fire or Act of God oaterecel"e, Oregon Revised Statutes(ORS)308.425 1 D-. 2_e 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 narr(e ,-----/ Phone / Q___Y'id t C -) "-(-t Li" ( i MaiGn address , , r Email(optional) G( )1 2oe�(, l Che I rn-e ,� -1 � ;nC( ieC( C)dc� C'I!>hhS City State/ ZIPj de fl Lo ion and description of damaged or destroyed property CCM Assesso1 Kaccpunt numb 5 ' Location of property(if different ro above) Section Township Range Tax lot number n-e "- lrh-- ifof personal;property _ Date of damage Cause of damage �� ` 5" -(�T( �� t j Ct-"i")) L-v 0 Fire(attach fire department report) TAct of God(describe): ��,c'-L LLJi (dC l�t Damage occurred to d 0 Building ❑Personal �property ❑Manufactured structure be damageb e / G t( C.e 1 L r-ty (, te--l,-G `I e d /// ,tk-No-aNLy A-Cfau Application for proration of tax kI 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 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. r ,� LO1 ( DLC x tor\ r v G�iJ � 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: I-2 cu -i Clerk: /Xf Date received: (U2 C/S0 Zo Clerk: -2.7-4* Damaged property: This year Land and improve ents: v Real market value(RKVI befo RMV after Date rebuild complete: Months prorated: ei fire/act of God: S f 7 0 fire/act of God: S!�750 A T TO V _„.l Assessed value(AV)bll Value f me n tiN` fire/act of God: ,7�� percent of loss: Destroyed property: CHANGE This year Personal property: NO V RMV before RMV after Months prorated: "' fire/act of God: fire/act of God: AV before Value Amount of adjustment/refund: v— fire/act of God: percent of loss: Remarks Date property visited: I D/'Z eft,Zo ❑Damaged 0 Destroyed LA-r-)6-o oty trzc r 150-310-083(Rev.12-15)