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(kcypAa-A_IS reccL�*' L)\�ii- • Application for Proration of Property Ta \ For county use only Due to Damage by Fire or Act of God u eksisr- oaterecelred 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 Margaret L Byers, McDowell Family Cabin LLC 503-569-5756 Mailing address Email(optional) 5911 Sconce Rd demabyers@canby.com City State ZIP code Hubbard OR 97032 Location and description of damaged or destroyed property Assessor's account number 541346 )2_.q1 L K ' Location of property(if different from above) Section Township Range Tax lot number 9570 Elkhom Woods CIR SE, 02DC 09 3E 00100 Description of personal property Lyons OR Family vacation house Date of damage Cause of damage 9/7/2020 0 Fire(attach fire department report) 0 Act of God(describe): Beachie Creek Fire Damage occurred to 0 Land 0 Building 0 Personal property 0 Manufactured structure Describe damage Complete loss if house, garage, woodshed and outhouse.All contents also burned in all structures.Trees burned, most must be removed because of the danger of falling. Application for proration of tax 0 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,and complete. X G(itJ li//-1�- i.)- - App t sig ture / Date —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: )Z-z9-2U Clerk: /' Date received: Clerk: Damaged property: This year Land and improvements: '-' Months prorated: Real market vale (RMV)before RMV after Date rebuild complete: fire/act of God: L7vi4,U fire/act of God: 14215 30 Assessed value(AV)before Value r�./6 9' Amount of adjustment/refund: fire/act of God: 14-7.1f/54 percent of loss: -' Destroyed propertyThis year Personal property: Months prorated: RMV before RMV after fire/act of God: fire/act of God: AV before Value Amount of adjustmentnd 57.08 fire/act of God: percent of loss: Remarks: Date property visited: 0 Damaged 0 Destroyed 150-310-083(Rev.12-15)