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cl_ E'rv\ a. 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 L 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'siname �n y,.- _ ri I I1 i 1 C'r}(-d c/o j..t) ''�c�S 4 r> A-&5e-4—MDPhon(e! ///� ��y.1W Mailing address r 7 " -guy- -,5aco `o City 10e iu )t)(----1-. 4.J e CA -� (�I. Stateh ZIP code (!C V Location and description of damaged or destroyed property Assessor's account number if 1 t.3 P2 k. \ A(( Oc3e 10-0o- OM 00 Location of property(if different from above) Section Township Range Tax lot number 1_,i 0 tel S 0 f�� Dscription personal property t, �1 Date of damage 1' damagev"•til of (-��.hr r r 6 Cr �� 6/r ,. 9 Cause of ' l ('( ( • `1'u� Vire(attach fire department report) ❑Act of God(describe): Dan{ e occurred to �(� �i and ❑Building ❑Personal property ❑Manufactured structure C.X. i �l! ,,A-e re Describe damage 6 , io.,_ -e [ c ac uX cavi ci �'it.9 a A 6, � ,�0yf 1,u-114.c-1; re . C-kAe kocl�i o i l cC fico ff ri-y ace (r: 0 0 7T/O Application for proration of tax 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 true corre. ,and complet . X (1-- r: % 1 I,0 1 2-4 )2-1) Applicants 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-/F-2/ Clerk:/" Date received: [z/I O/j�j Clerk: Z. 7.---4--L( Damaged property: This year Land and improvement Date rebuild complete: MonthspH-0..10'V' Real market value(RMV)beforg RMV after ? 1014 o�p;pugfire/act of God: 2()f 06 0 fire/act of God: 320 06 i� Assessed value(AV)bef re Value1_+'`'va tVs1�1111� fire/act of God: J(�, O 30 percent of loss: 1C/ Destroyed p M N�G0 1�+WV�� This year Personal property: ANO C G Months prorated: RMV before RMV after fire/act of God: fire/act of God: 1 AV before Value Amount of adjustment/refund: fire/act of God: percent of loss: Remarks: Date property visited: 14/0/Z.474) ❑Damaged El Destroyed LA-i-SIO- ONLy PK-auxin 1 150-310-083(Rev.12-15) t i e t I i