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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 Phone 4tG etiti 77tiv e �b3- I'-31 S7 Mailing address Email(optional) A a, 69/ 60V emerciree.riapPAle City State IP code . b,;(:)/4,:ni4 04 923es' Location and description of damaged or destroyed property Assessor's account number M325233 / 325233 Location of property(if different from above) Section Township Range Tax lot number 270 Front St N 01 BC 10S 5E 15200 Description of personal property Detroit, OR 97342 Date of damage Cause of damage 49 ?02 ) Oire(attach fire department report) ❑Act of God(describe): Damage ccurred to! `' Land ❑Building 'ersonal property Manufactured structure G�� v Describe damage ` v 11,(., 1-8•01214' =Or.4/..444ZIE,Ore-14 \ 44 d/ a OCT \ °Z$C.‘ ov 1,‘C)_4:/% Application for proration of tax am applying to have the above property examined for proration of property taxes per ORS 308.425.Application must be submitted XI d 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,a complete. X /0 /S 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: !2,-23-20 Clerk: /i'' Date received: I I-7 5s-2e 7,0 Clerk: 77-7-44-q Damaged property: This year Land and improvements: Real market value(RMV 4@forp RMV after Date rebuild complete: Months prorated: fire/act of God: 411700 fire/act of God: i4.6 I Assessed value(AV)befgre Value �p b Amount of adjustment/refund: -- fire/act of God: 3`I 730 percent of loss: Destroyed property: This year Personal property: 9RMV before RMV after Months prorated: fire/act of God: fire/act of God: AV before Value Amount of adjustmen refund- /13'8.7f' fire/act of God: percent of loss: Remarks: Date property visited: II-2-5--Z0Z0 ❑Damaged XPestroyed 150-310-083(Rev.12-15)