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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 k p-at - 2(5.2(-_.) 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 Jeremy Ballard 503-507-8573 Mailing address Email(optional) 25227 Taylor Park Rd. SE ballardjw76@gmail.com City Lyons State ZIP code OR 97358 Location and description of damaged or destroyed property Assessor's account number R40939 / 540939 Location of property(if different from above) Section Township Range Tax lot number 25227 Taylor Park Rd SE 15BB 09s 2e 300 Lyons, OR 97358 Description of personal property Home, Shop, and Pump house total loss to fire Date of damage Cause of damage 9/8/2020 ❑Fire(attach fire department report) LI Act of God(describe): Beachie Creek Wildfire Damage occurred to O Land Z Building l]Personal property E Manufactured structure Describe damage Fire destroyed the home(all contents),shop(all contents),pump house(all contents),as well as 6 vehicles, 1 boat,and one flat bed trailer.Also destroyed 30%of 180'cedar(6'tall)fencing. Fruit trees,as well as large fir trees, maples,and pacific yew trees were destroyed. Application for proration of tax 13 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 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, rrect,and complete. x �e(ev47 get J(Gd 10/8/2020 Appf7 signature ' Date —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: 2-1-21 Clerk: (11 Date received: Clerk: Damaged property: This year Land and improvements: Real market value(RM belga! RMV atter Date rebuild complete: Months prorated: M//0 }3,) `Y fire/act of God: fire/act of God: al ii}'` ,T V Assessed value(AV)before Value a nt rewp.• HT fire/act of God: ��i percent of loss: Destroyed property: GE TO t This year Personal property: NOCMonths prorated: RMV before RMV after fire/act of God: fire/act of God: AV before Value Amount of adjustment/refund: fire/act of God: .v percent of loss:_ Remarks: Date property visited: ❑Damaged Destroyed i By J kce r f gc 1 b-2•S-ZD 2t7 150-310-083(Rev.12-15) _..___. .___._. __ ___.__.---__. __-__-__......_--__.-_ j