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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 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. A licant's namk Phone _ r} LI Mailing ad.ess Email(optional) L �i' ( S illi CSC FIl C f ► \P 1CC t ity State' ZIP •.e1 UM • Location and description of damaged or destroyed property Assessor's account number 136203/R136203 Location of property(if different from above) Section Township Range Tax lot number 11096 Mobley Ln SE 15BB 09 2E 402 Description of personal property Lyons, OR 97358 Date of damage Cause of damage ( J G-g-2o ❑Fire(attach fire department report) AkAct of God(describe): l k3 ‘‘, f_ it T 14 ( (} „At . Damage occurred to Land d'Building Personal property (Manufactured structure Describe damage ,� 1 t t 0,‘ 11 S c ► ► ) 1-...Ah�. it Ctrl, r; b , j.� s ,. )t Application for proration of tax C XI am applying to have the above property examined for proration of property taxes per ORS 308.425.Application must be Wmittte Z O within 60 days of damage or June 30,whichever is later. — p co 44 Whether my property is damaged or destroyed will be determined by the County Assessor's office.If the assessor determines my property i ly dacia•4 z co 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 alcu�te and finalize the tax proration. (,(,,,t c. `L < cr 0 .;S 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 isfr e,correct,and complete. X '''EM 72'ik•Okinijt__LQ /' ) ‘661 )-C ;10; Applicants signature Date "J —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use oI. Date received: Clerk: Date received: /0—2.1-- 2.19/0 Cler 0 Damaged property: This year Land and improvements: ---_1 Real market valuefp beforgg RMV after 2.7 Date rebuild complete: Months prorated: fire/act of God: /bee. 0 fire/act of God: 000 Assessed value(AV)— be or Value U Amount of adjustment/refund: ' fire/act of God: 7,04a percent of loss: Destroyed property: This year Personal property: RMV before RMV after Months prorated: fire/act of God: fire/act of God: AV before Value Amount of adjustment/refund: --- -- fire/act of God: percent of loss: Remarks: Date property visited: ❑Damaged Destroyed 150-310-083(Rev.12-15)