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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. Apicant's name Phone 11 11 �� -�r�'7/ .3d3 61-se 4 LI! 7 ailing address / Email(optional) 023322 C,tia-Efe / L !12e State ZI�P/c�o CitA Ura r ci O � ! O-, Location and description of damaged or destroyed property Assessor's account number R40154 / 540154 Location of property(if different from above) Section Township Range Tax lot number 8521 Elkhorn Dr SE 3 a-&- og 4e 0 I(000 Description of personal property Lyons, OR 97358 Y �( ,-r_ Date of damage Cause of damage Y I/z 1 y1 �� j�f,�rj e (IL- 5pq(-7 , 20 2,(;) I=I Fire(attach fire department report) ❑Act of God(describe): I ei l ) I Damage/occurred to ❑Land $¢uilding ('Personal property bA Manufactured structure Describe damage 1-&f-a- 1--455 bUt ial lle{5 a-oet C(30-1..eI44-5 J Application for proration of tax lam applying to have the above property examined for proration of property taxes per ORS 308.425.Application must,i0c)bmitted 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 determi - v rtoperty is i'k dam- aged,I must notify the tax collector of the date that the damage is repaired.Such notice will serve to inform the tax cone", . their dyay -culate and finalize the tax proration. �`O. QV O J�,-Ck Declaration \`� c<5 �0 ' � 1:..5-''' 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 PALA 3 . Z n Zo App icant's signature • gate —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only - Date received: (2.-2q-20 Clerk: Qk Date received: 1 I 30-ZO Clerk: (, "J U(p Damaged property: This year Land and improvements: Real market value(RMV)before RMV after Date rebuild complete: Months prorated: fire/act of God: 073 ID(o(oO fire/act of God: La.D 330 .---. Assessed value(AV)before Value I�O� Amount of adjustment/refund: fire/act •of God: (S( SQ percent of loss: Destroyed property: , This year Personal property: MonthsRMV before RMV after prorated: fire/act of God: fire/act of God: AV before Value Amount of adjustmen refund: ga7,07 fire/act of God: percent of loss: Remarks: Date property visited: /a-y ❑Damaged, OFF 0A-r)eivu: 150-310-083(Rev.12-15)