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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 t!, - - :3- �� " 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' name i rI .. tie T n &T(4 of a Lary \f) �kb s e AS5e-A--)J,�,4- Phone 0 -gb7- 3 C� Mailing address Email(options � L _ -�s- 1 �� z s be(option* tic,(OM City State A ZIP code k)ec 1b1 Ze. -N C 9a660 �� j� Location and description of ffjdarmaged or destroyed property Assessor's f�'} �(�/� (� Asses 's`I c1 D.a number 1z..4 1 3S'(--(L O43 I I-IN � 0(4 l/0 Locationof property lif.differe t ror ove)� l s Section Township Range Tax lot number rof DLecU- r ription of ersonal prop r� L\I on S 0 t;N r Ir t/b Date of damage Q ti Cause of damage —J� ()K . t 1..,2.i.) -wire(attach fire department report) ❑Act of God(describe): DDa e occurred to A and 0 Building 0 Personal property 0 Manufactured structure 15' ? 4e re_ 5 Describe damage 6-bC .0 co �.- 10..vi c V-��- ed c -S4-{-0)1--el b 0,:.-}-3- ' 'C i� ( t'Y1 VT/ 0zv Application for proration of tax t14 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 a penalties for false swearing [ORS 305.990(4)]that I have examined this document and to the best of my knowledge it is true corre ,and complet . X (1--- flA „ 2-q.t. 10 2--0 Applicants signat e Date —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: 1-18.21 Clerk: /r Date received: 11/(0/Zv Zv Clerk: ZT Damaged property: Thi��'_`— year Land and improvements: Real market value(RMV)bef9r RMV after 1, c- [p Date rebuild complete: Monntkioir r� fire/act of God: 1(57,6 n 0 fire/act of God: 't J1. ��U 0 0 AD 1 �1,`pe V N� O�N Assessed value(AV)before Value d41 Pian aNIA --� fire/act of God: 19 7.600 percent of loss: !� Destroyed propel Cli `� This year Personal property: 1`�� RMV before RMV after Months prorated: fire/act of God: fire/act of God: AV before Value Amount of adjustment/refund: '1 fire/act of God: percent of loss: Remarks: Date property visited: 12/I 0/20Z-0 0 Damaged 0 Destroyed NC-ot ( iGGf9L4 150-310-083(Rev.12-15)