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Clear Form 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 Sco7T 8. f- TAntc T C. 1-: 'A5s E rr 503 - 3404 -(Ao(0 Mailing address Email(optional) psa.L13 LilLDwoo5D 'ISR sE bctsset3@c..cord City State ZIP code SALEM Of., Ct7 3o G. Location and description of damaged or destroyed property Assessor's account number 84113+0 `ft1 -6( Location of property(rf different from above) Section Township Range Tax lot number l l 4 l L. ©LD B1';(DXF LT SE Description of personal property t-YoIJS OR 43--355 Date of damage Cause of damage /7 R Epola- IS 14a1 A,YP I!A BLE To us y - GI`d 12020 JFre(attach fire department report) 0 Act of God(describe): Damage occurred to eIC) 0 Land 14 Building 0 Personal property 0 Manufactured structure 1 Describe damage V 10411_1 loss 6v louse_ and de-tact !erg 9a-r-Ce.. fi-oyin fire. . ` ¢�G�` rOti� OCA 1 OJT Application for proration of tax �' tom`PS' I 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 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,l' ...„and complete. , ___Liki, Appnt s signature ro�l�-l�aoao Date —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received i 2-15-10 Cleric f received:ceived: 1 /6 ZO'ZO Cleric Z T -If Damaged property: This year Land and improv • Date rebuild complete: Months prorated: -- Real market value( v) RMV after *afoot of God: 2 21, o fire/act of God ?1,95-0 Assessed value(AV) ore Value Amount of adjustment/refund: fire✓ad of God: I S O,R Zo percent of loss: 14 5-,-/% Destroyed property: This year Personal property: Months / RMV before RMV after fir elect of God fire/act of God: AV before Value Amount of ad refund: 557.66 unelad of God: percent of loss: Remarks: Date property visited: I l/6/1-4-. 0 Damaged ((Qestroyed 150-310-083(Rev.12-15)