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I f 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 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 "t ` ,p (�•� Mcav hr.a. 1 %Vein r0- cf-� LLC 1 c n A Phone O 3�V Mailing address C�C �w`s� Q O - g a g 3 5�t_ i !e ^C Ave. Email(optional) (� ��. 7 tv 1v of 7 /} M 1 kCi o W Sc 1r W 1 e 5 cowl C' �artlah Stat ZlPcod� 0-I 2...Location and description of damaged or destroyed property • t Assessor's account numbe Rii ii l$ r:-)(4 W I ed Location ofproperty(if different from above) Section Township Range Tax lot number a.2$a b .SeyNuNie .k0-. SC Description of personal property IN/0 v1s l OR 1113 5t LIVicl.4 - F) T0+4,,l CD„'.}c-Y.-�s er( ÷t,L lit ovie • Date of damage Cause of damage 01- 0' — a ),) ❑Fire(attach fire department report) Oct of God(describe): ileac.*�e Grcc-\C. F re Damage occurred to $"Land SBuilding '.Personal property D Manufactured structure Describe damage Q To+L1, co..... Oe'Ve toss � Q\ :A-T- ,ih 1 W c j cc ' ' > oo Lu U w C7 o co Application for proration of tax W ov coQ I am applying to have the above property examined for proration of property taxes per ORS 308.425.Application must be submitted 5 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. X r2 -L , C . 14 e,-. to- kO- 2020 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: Date received: /0 -2-1- SIDZW Clerk: C L /o Damaged property: This year Land and improvements: /- --- Real market value(RMVj��efore RMV after Date rebuild complete: Months prorated: fire/act of God: (J S/) fire/act of God: I g 51 7 pG 0 Assessed value(AV)be Amount of adjustment/refund: fire/act of God: 2.f25 -20 Value percent of loss: S 77 Destroyed property' This year Personal property: Months prorated: RMV before RMV after fire/act of God: fire/act of God: AV before Value Amount of adjustment/wlt.* —30i/.51. fire/act of God: percent of loss: Remarks: / Date property visited: EI Damaged 7ipestroyed 44 i yf' c4sr",,trc 150-310-083(Rev.12-15) 1 l 1