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Application for Proration of Property Taxes i-or county use only Due to Damage by Fire or Act of God Date received Oregon Revised Statutes(ORS)308.425 I ( - D 262 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'I 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 f. hone 1kltrn (ITPCIO �i ' C ,,l11\ 3' MD P-76y0 -'-b7- ,� 1 Mailing address R549 5 9 —8 1 `i. i ) / u /�'1r'Dr 1L ,(1 c E+,mail(optional op 61--? delico C tri City/J e io o,c -6 e 1 State ZIP code Location and description of damaged or destroyed property Assessor's account number 1 1 1 -3 3 .- t 1333 09 t"10-OD- 00100 Location of property(if different from above) Section Township Range Tax lot number J� �� O D scription of personal prop:rty �-7 L "C IA-5 ee'. rr 1 r it�r [j l�/� t�/f t�- Date of damage ( A Cause of damage COX . i--1--- wire(attach fire department report) ID Act of God (describe): r Dartl a occurred to f� rV�, A and ❑Building ❑Personal property ❑Manufactured structure, -f , ) A c-(Z? Describe damage i 6*–t 1 c a0 Lk-(-5 -e- lay)A yet-vra,k9 e-cl 1 el 1,ii I r red : a&ea- - `o`� t fCb efty (5C ' u( re Qv, 7 g,LL2° 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 truere. ,and complet:. xa z9 2--O Applicant's signat: 1 Date —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: 14V-20 Clerk: Cr. Date received: I2/I O` ) Clerk: T Damaged property: Thii Year Land and improvement0/Z4'7.4 •7 Date rebuild complete: Months oiroli# lU Real market value(RM efore RMV after C 'Tv '►V fire/act of God: 1 `16 0 fire/act of God: 31"f,0q , K6a Arialog e.'wY�p�°141 Assessed value(AV)before Value II>Jl [ fire/act of God: I $', Sv0 percent of loss: Destroyed property:"O`' This year Personal property: 1`� RMV beforet Months prorated: RMV after fire/act of God: fire/act of God: : AV before Value i Amount of adjustment/refund: fire/act of God: percent of loss: k Remarks: Date property visited: 12/1O''LBZc ❑Damaged ❑Destroyed L in -001.-i k-C.0 o:&F 1 1 150-310-083(Rev.12-15) e, i s