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6 .( f-v-v,L, 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 �` • 2t..'2t)._CD 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 ):ht T n C, (4 c/ 3 vv)Sfty 1e .,4-s,5e. --�J r,, - Phone7 62 0 -g-b7- 3a,),0 0 Mailing address R 5, +n —6 n / ) / O r J1.41 c Email(op nal y (�r t: - '�j � =ori- �p c ��t,�1�� tit, Car CJ State ZIP code 110 eL0 f+ 13e_ct J (c - 9x660 Location and description of damaged or destroyed property Assessor's account number 5'4 I3-7 �3�10—DQ-'� � Location of property(if different from above) Section Township Range Tax lot number 1;4 t �� D scription personal prop r rty lir- v t of tA,S ed 1 r-terAG erf i t t 1 re- Date of damage (I it Cause of damage CO K . 1` /1. ` ire(attach fire department report) 0 Act of God(describe): Darn e occurre)14 d to and ❑Building 0 Personal property 0 Manufactured structure rj i2:1 ,Ace-re`, Describe damage (1-t 1 c CO U‘t.,(5 .e,- 1 00'1 ci Yk V-LI-1/45 ej A -'.S-- -1-1rt ) i \f-ell tu: 14.- , red . C-v e ()Locke,0 c e-ca er Occu (1 0i,, ri- 7 Yi6)21) Application for proration of tax 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 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 e penalties for false swearing[ORS 305.990(4)1 that I have examined this document and to the best of my knowledge it is true come. ,and complet . x , 1 LO 1-412--0 Applicant s signat Date —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: Z-/j-2I Clerk: /7( Date received: 1 Z/I 0r20 Zti Clerk: Z7 II Damaged property: This year Land and improvements: Date rebuild complete: Months prorated' ..�AN�.� Real ctmof God:et value(RIM b fore RMV after tJG fire/act of �{,/ fire/act of God: 15/7 TO T 1 10 .mart Assessed value(AV)bet re Value o��4�e tei�A p fire/act of God: 2.5,Zq O rij Destroyed property:IV"� E 1 percent of loss: Q^U 1�NG This year Personal property: N *INMonths prorated: RMV before RMV after fire/act of God: fire/act of God: AV before Value Amount of adjustment/refund: fire/act of God: percent of loss: Remarks: Date property visited: I Z/I d/ZO 2'0 0 Damaged 0 Destroyed �,�` L N)-o- L Y AGGo4P7 150-310-083(Rev.12-15)