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Application for Proration of Property Taxes Fo' zrce, _�-''wi Due to Damage by Fire or Act of God Date received Oregon Revised Statutes(ORS)308.425 1 i I t Instructions: •Application for proration of property taxes may be made for the tax year of the property damage/destruction.If approved,thi icecitlr eohtf, mount of tax due or result in a tax refund.The tax year is from July 1 to June 30. � UIIVV l:V NN�I YY •Your application must be filed within 60 days of the damage or by June 30 of the tax year in which the damage occurredT,Micaisri •File your application with the county tax collector of the county in which your damaged property is located. Applicant's name , Phone MailingaddressC41 C/141/v� Cfv LI g S. S i 9 Email(optional) l 9.0 3 c Cit kAry 1 LOV Sttc� ZIPcode 5 3 ` Location and description of damaged or destroyed property Assessor's account number M131654 / 131.654 /7/?�' 62,9 adv (9/bi0 Location of property(if different from above) Section Township Range Tax lot number '''''"i`Z4C7UU IWJL1I I-Urr%f\U JL ___ _. ____.___116-__ vT1. __.--- Description _Description of personal prrty Lyons, OR 97358 Date of damage Cause of damage 0 Fire(attach fire department report) VAct of God(describe): Damage occurred to ❑Land 0 Building 0 Personal property 0 Manufactured structure 4G Describe damage v 0‘.6> tioti° ....../ 1 .,� I k./ 4 7 __ % . -I , 0% „)\''' G P Application for proration of tax �.\` �, cc,,� 0 I am applying to have the above property examined for proration of property taxes per ORS 308.425.Application mugbe mitted 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 Al . : v 71 At? Applicant's signature oate —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: U-40-7,0 Clerk: f� Date received: J I - 3- Zp Clerk: /Ai✓ 0 co Damaged property: This year Land and improvements: ,..- Real market value(RMV)before RMV after Date rebuild complete: Months prorated: fire/act of God: 83L-,�j fire/act of God: Assessed value(AV)before Value 1 .Q Amount of adjustment/refund: fire/act of God: ,- (04:1U percent of loss: Destroyed property: This year Personal property: Months prorated: RMV before RMV after fire/act of God: fire/act of God: AV before Value Amount of adjustmen refund 2 1 '7 fire/act of God: percent of loss: Remarks: 5r Date property visited: 12-'3- 20 0 Damaged C estroyed 0 Sr;5 i�°°C--?/Oena 150-310-083(Rev.12-15)