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I Application for Proration of Property Taxes For oeunty use eniv Due to Damage by Fire or Act of God oOrec tiiv Oregon Revised Statutes(ORM)3011.42b instructions; •Application for proration of proper taxes may be made for the tax year of the property damme/destruction,If mimed,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 RD days of the damage or by June R®of the tax year in which the damage occurred,whichever is Tater. •File your application with the county tax collector of the county in which your damaged property is located, Appli§anV§name ~ r S ---R�.V,S T ©,r..f e, Gt)a.c sal icr Rhone f r Mailing address �R4rt.�y'Q l 7/14.r R`fG,--I.257 O 2, 6•A''fent• Email(optional) gly off .gf.4cd e • 9;261i, -C A 9 :24.Y7 •en on on• •sea • ,on , •n me: • or •Mr* • :ro•e §§@§§9 §a000Er- num=@r JEW ., 8 �! 5 Yco0 r,-vLrCJJAC°el.; Ai©.5. �'C� � I_oeation of property(if different from above) Range 2_578/78/ :4 4014 P. c@gtio o �own§hO q �agg@/ g Tax let��`@@r �� id's', "/ � . O:) ie , O1C §onpti@�@ per§en. property � Doty ofaanr @ u+4AvtSiiiArrvs . eArth"et)y Dae§o of damage SAW"- g;5, 0.G.LD gFire(attach fire department report) 1fAct of God(describe)€ WM-17F/P..$ Damage muffed to 53 Land Ci Building ®Personal property Manufactured structure Neville damage h'14'refA,4CT'E/l2TEL3 Afoiri 7Go ,4J/i 4: sT4ore `aPF__bticeo res Atif03S 7—ono4 eo.cfrka/s's,pQ - oAsa-4 PAop. .Ee_X/.r/4- Z. . . 44 . oi47� f�uinjr -.+thus 4,vP o iii 0eiIi'D�N'9 5 -4GSO Y r.¢GLy b.'s.l0:Rc .zro; S , Application for proration of tax WI I am applying to have the above property examined for proration of property taxes per ORB 306,4K Applioation must be i ed within t30 days of damage or Juno 30,whichever Is later, _�,�Q Whether my property is damaged or destroyed will be determined by the county Assessor's case,If the assessor determines my F.-__ji. is onl m= aged,i must notify the tax collector of the date that the damage is repaired,Duch notice will serve to inform the tax collector F- ,,,;' =uty to and finalize the tax proration: Declaration �O o�G55p� Q _ i declare under the penalties for false swearing[ORB 306,900(4)1 that I have examined this document and to the best of my knowledge it is true,correct,and complete: -- -„ .1� _" ,til, .844,4& ., etP e.r. Z.? 2-o —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: 2-4-21 clerk: fir Date received, Damaged Frope m11c Dlork€ W d(o This year Land and improverr�ntsi Dat@ rebuild complete M® Real market value(RMV)before RMV after NT T� i�"Q � fire/act of tied; 15 i Si)() firs/ at of Oed //O OG 2 ' ____Gitttl Assessed of v ode; (A1�4 I �re Vpeip nt of len ® yam : CHpri Thin year Peers�l�perty, Menthe prorated: RMV before RMV after lire/got of cod: lire/act of tied Amount of adjugtmont/refund€I _. AV before Value fire/eat of OW: pe►cent of loss %met*: Date property visited:_/_ ,- 'lZL)„ ®Damaged,gestreyed //L 1l// /I , oli i§e-§90=0@@ pow 1grt31