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�� ) Application for Proration of Property Taxes Fp�For rrounty use only Due to Damage by Fire or Act of God Date 1A0 ' Oregon Revised Statutes(ORS)308.425 Instructions: - --)j-- - -2_.C2 -A-< _ •Application for proration of property taxes may be made for the tax year of the property damage/destruction.If approved,this of tax due or result in a tax refund.The tax year is from July 1 to June 30. may reduce the amount •Your application must be filed within 80 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. s name v�ii� 17Dif(�,�JJ •tri kr5 Mallin add 1 Q Y nL64r� t 1�i/ PB� �,,. ) '� O4in add43 r gb �.aC �C7C11 S' I U `��'v{y.�.-i ETi, Jwc it t tionjCity 0(4Bet tocode ' 60 Location and description of damaged or destroyed p opertY r I a6 �v`Za��n eber�(p < Location of property(if different f m above l 3 (1� /{,b/ 4- �� '� r Section Township Range lot number ��p n 5 i TQ ( Description of personal property !Tax V1'lxsftmes- Date of damage Cause of damage �'� pccK. 9�20 I Fire(attach fire department report) DAct of God(describe): Dam ge occurred to ktand •>:uilding 0 Personal property 0 Manufactured structure Describe jd age � � , f (SSB t C©u5 >✓ elwtprnat - 5{� '1�es .tfies "- co'• re6+ all ikir e4 b Ir`-ecevt`t- wt t J-it rs. �a-C u.ak."h``o n o4: .�11 ) ' ' it 6 :e, ,-1- Z 0 i Application for proration of tax KI 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 truea- Applicants ,o .0,and compiet j1 X . V�3 /V\ ,(� sign., �iq '� Date —Applicant will be notified of the county's decision— For tax collector's use only Date received: 12^� f For assessor's use only Damaged property Cleric:nt Date received: 1210//Zo Zo Clerk: Z T 47 This year Land and Improvements. Date rebuild complete: Months prorated: Real market value(R ore RMV after fire/act of God: /,I''J/17 6‘ flre/act of God: 9 e 7, 9V Amount of adjustment/refund:I ---� Assessed value(AV)befo Value N °/0peslroyedpertyfire/act of God: 00 0 percent of loss: This year Personal property: Months prorated: RMV before RMV after fire/act of God: fire/act of God: Amount of adjustment/ / AV before Value 3 �6`f'6 fire/act of God: percent of loss: Remarks: Date property visited: f2/13/LoZ0 %Damaged 0 Destroyed Got.F CoH,teSE 05L) i,-'mrr• 644Obo4 lmfr,204-r,..Ais Nor; �e.gv. 150-310-083(Rev.12-15)