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e NI • 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 rii / II Z 47 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 NIYI I— . 4. jaV\i.nl✓ (Ut , 6aae 503g.71 (,01i Mailing address Email(optional) Po re 5 ibe,ie_e.c 6 w v 1 . um City State ZIP code UCe ps U X113 Location and description of damaged or destroyed property Assessor's account number I t'/CO `iI ('W( Location of property(if different from Bove) Section /7,4 Range r+ Tax lot number 23131 Sa I m o�Ix rl-rl SC 1784 O el 0/t 6 I Description of personal property UVovtsUr2 A13% Date of damage / Cause of damage q_U g-2 0 a 0 M Fire(attach fire department report) xAct of God (describe): 6,44It.('re,,,K F Damage occurred to ®Land E Building ('Personal property I7 'Manufactured structure Describe damage ai' g uA at1/4ito5destpodcs i po 1Mer a 1.t✓ Application for proration of tax 5iI 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 b,, - )441,,,k.,_ . . q - �l - ov,90 App ca is signature Date —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: I-7-2-1 Clerk: 171 Date received: U—1,,,ZU Clerk: teIIV D le Damaged property: This year Land and improvements: Real market value_(gvt 4e4xe RMV after 6 WO Date rebuild complete: ^— Months prorated: fire/act of God: Q fire/act of God: 7�/ �� Assessed value(A abbe grr„ Value �' ' g g fo Amount of adjustment/refund: fire/act of God: `"'77i percent of loss: V Destroyed property: This year Personal property: RMV before RMV after Months prorated: fire/act of God: fire/act of God: AV before Value Amount of adjustment/a ¢6 3. g fire/act of God: percent of loss: Remarks: Date property visited:J OS4w^ � r r el-_,2,2 - � El Damaged Destroyed 150-310-083(Rev.12-15)