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Application for Proration of Property Taxes For minty use only Due to Damage by Fire or Act of God Date Oregon Revised Statutes(ORS)308.425 Instructions: •App on 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. your application with the county tax collector of the county in which your damaged property is located. Applicant's name F \��Z11�G CS \--\ _ --C. ' Phone Mang address �"`l-`-4B` "Z Emile(optional) r5V(pS % ..) t8ck ,�NLC \ t a m& ,\.4 o`��C r+�ily ZIP code C '1 \ State tion of damaged "l�O�,�'j Location and description Assessor's account number P • or destroyed property �‘"-\`-.2 5-tl 1 I CNI /J' 1. W Location of property Of different from above) Section Tovmship Range Tax lot number 3:30\ vFrik.:c\."0 • o` D1 E. trt-441)a Desarption of personal property yo CA.S r c O1--.. 1% .J?�N� % 2a 1/41.k1`r�N.C. ec `'`� Date of da?rrape cause,Z)Zu ,of -lv ,a I bees(atter fire department report) 0 Act of God(describe): ❑Building 0 Personal property 0 Manufactured structure VQ Describe damage ,4- , N,) ,otio$ �,� \& \C=\\.\ �••C : � 4C t \ o- Go o0, Application for a, proration of tax �cj.�Z5 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 dam- aged,I must notify the tax collector of the date that the damage is repaired.Such notice willserve to inform the tax collector their duty c�akxAate and finalize the tax proration. 1 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. AamtC\�`S _O O\ —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: 2-2.3-2.1 Cleric (Z' Date received: qac: Damaged property: This year Land and improvements: I Date rebind complete Months Real market value(RMV)before RMV after 64 pp ggtadeuein`,� fire/act of God: C S/�Z 10 fire/act of God: O�/20Y Assessed value(AV)before Value fire/act of 1 Go NO C%U This year prope fty 3G1 percent of loss: Months prorated: ~ RMV before RMV after fire/act of God: firelact of God: adjustment/refund:I AV before Value Amount of a 'tfire/act of God: Parent of loss: Remarks: ` Date property visited: 0 Damaged 1Zbest oyed • - - and in i " -- &D t A k A., - i'-'itin... 20,7-4 efo t 150310-Oa task 12-151 I