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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. Applicant's name / �t Phone 40e..12 o%// C� '' t--e/172-22 . y/e-7/'�. f‘o 9 Mailing address Q,/ / Email(optiona)D J" 0Z1 �7 .r// 'c1 e,, S ` eiie 4d 4/t Ces' -2,T ('A., City ---- State ZIP code �y��-Ze/ 8 2 Y74,o Location and description of damaged or destroyed property Assessor's account number ot s (`-clod, 2.4 Location of property(if diffe_re from above) Section Township Range Tax lot number ,757 4. u/ f�RK,(cJ 0, e• Description of personal property 47=717 ©g7735 ? smear Date of damage Ca e of damage !:/,,1-eir�0 ,Fire(attach fire department report) ❑Act of God(describe): ccurred to OOO ��, Nl,LandBuilding kersonal property LIManufactured structureur Describe d age S� ecloye /� „1/„ et CO j �e),AXI Pe --7, . ,[ SP7`i0 -�5: G�� Application for proration of tax ,st''((�� I am applying to have the above property examined for proration of property taxes per ORS 308.425.ApplicationSSt be s �" within 60 days of damage or June 30,whichever is later. �O•gc�0 Whether my property is damaged or destroyed will be determined by the County Assessor's office.If the assessor determines my Ty 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 and finalize the tax proration. Declaration I declare un er 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,c rect,and com t impi X .ems/ /4.Y/1/. .?0'. o Applicant's signature Dote — • • • icant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: I2-12-Z0 Clerk:/f Date received: Clerk: Damaged property: This year Land and improvements: Date rebuild complete: Monthsprorated: — Real ctmof God:et value(RMV)before RMV after 3/ 5/0 P fire/act of /!t_L///�-GA fire/act of God: (/ Assessed value(AV)before ,,, Value �/ ,2 Amount of adjustment/refund: fire/act of God: 79/`/ypercent of loss: •GC/J Destroyed property: fl This year Personal property: Months prorated: RMV before RMV after P fire/act of God: fire/act of God: G G AV before Value Amount of adjustmentefund I 5 1 ' l 0 fire/act of God: percent of loss: Remarks: Date property visited: ❑Damaged Destroyed Pith-DC Seo L .1�rt�'2.r —I ift /0-2:3/2.02e) /0 L/ _ 150-310-083(Rev.12-15) — --