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�u Application for Proration of Property Taxes F, Fartir county use�C only Due to Damage by Fire or Act of God °81e`°`"Ved Oregon Revised Statutes(ORS)308.425 i l_ -t- Zc%Z-� 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 Michael Coursey for Coursey Enterprises, LLC 503-302-9347 Mailing address Email(optional) 5192 Bates St.SE City State ZIP code Turner OR 97392 Location and description of damaged or destroyed property Assessor's account number 598165 ZC it, `L_S Location of property ft different from above) Section Township Range Tax lot number 110 Santiam AVE W Description of personal property Detroit,OR 97342 Detroit Lakeside Motel Date of damage Cause of damage Beechie Creek Forest Fire 9/8/2020 ❑Fire(attach fire department report) 8]Act of God(describe): Damage occurred to El Land 0 Building 0 Personal property ❑Manufactured structure Describe damage My buisness was called Detroit Lakeside Motel located at 110 Santiam AVE W,Detroit,OR 97342. In the Beechie Creek Forest Fire,my place was burned to the ground on September 8,2020. The trees are severly damaged and will most likely have to be taken down as well. I am appling for a proration on my propery taxes since the value has greatly diminished , • Application for proration of tax l❑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 wiN 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 Ise swearing[ORS 305.990(4)]that I have examined this document and to the best of my knowledge it is true,correct,ant pie x11/09/2020 Applicant's si atum G Date —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: I'L-t 20 Clerk:/r' Date received: 12/02/2020 Clerk: ZJ#4 Damaged property This year Land and improvements: Real market value(RM before RMV after Date rebuild complete: .r Months prorated: fire/act of God: 456,220 fire/act of God: 130,570 Assessed value(AV)before Value Amount of adjustment/refund: ` fire/act of God: 360.360 percent of loss: 63.8% Destroyed property: a This year Personal property: RMV before RMV after Months prorated; fire/act of God: fire/act of God: AV before Value Amount of adjustme refund. 2415.73 fire/act of God: percent of loss: Remarks: Date property visited: 12/02/2020 0 Damaged ®Destroyed 150-310.013(Rev.12-15)