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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 \`- ;_ 0.26-A=-) 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 1k.t,1b r n &( C o ...J-11 N'.,PS1--Cb re ,i\-&,5e4--M,)� 7 l 0 -g-b?- 3a:),0 Mailing address ,i^ R 54 p —4 J n S�/ '1-C� r A-L i C Elom (options e t/,r tit,(o (or CityStali e LZ.eI 1 z -N (Cde^ ZcI/P��jco^d�e j 6 0 Locationonand �description of damaged or destroyed propertyr (� / /�/�j Assessor umbffil ('3unt fl /` cif 3-17 6'93G'0.'” W -C 6; 0 Cr Location of prop(if different frqn at Section Township Range Tax lot number D scription of personal prop rty/�L\I O( S O (� soCuSeL r S2tr1j-Y Ve 6cg- Date of damage n Cause of damage b t �' (D K . t"1 � Vire(attach fire department report) ❑Act of God(describe): Dari a occurred to and ❑Building ❑Personal property Cl Manufactured structure 137 A C(':e S Describe damage t C' &bt c a0 Lk( - t&vc c� Va_o.-Cl A (+ o\1-e? i, do 11 c�-�t re . Cc lit()L T) oil tC , -o f,14-y (SCC a (re d ca d� p 7 Y,Le Application for proration of tax iI 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)]that I have examined this document and to the best of my knowledge it is truerre• and complet . xr i t e 2-q z--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: 2.-IX-21 Clerk: /`ti Date received: 1211 O 202 0 Clerk: Z T. (,j Damaged property: This year Land and Improvement �� 'Months provied;e• _ Real value(RMV),pof rP� RMV after Date rebuild complete: ' �y G e r 10 11AL�J`; fire/acctt oof f God: SIA y f $4-1 fire/act of God: 1 Assessed value(A before Value „[ Ao� �W "_ fire/act of God: `j 7,9,j O percent of loss: /VI Destroyed properarlo G 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: fire/act of God: percent of loss: Remarks: Date property visited: l ZIIO/7_O 2 0 ID Damaged ❑Destroyed ST oAAr V6 C1Id� 6VI 613 gtir Ga � f_Co �sc oSas t - rLy vvkf c7 0 150-310-083(Rev.12-15)