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RECEIVE) <br /> FOR ASSESSOR'S USE ONLY <br /> Form OR-C-RHSA-2 Date Re evej <br /> 3 <br /> Page 1 of 1,150-303-009 Oregon Department of Revenue Approved Denied JA 2025 <br /> (Rev.07-26-24) <br /> Date: By: MARION COUNTY <br /> Attestation for Continued Qualification of Rebuilt ASSESSOR <br /> Homestead Special Assessment Currently Specially Assessed? Yes No <br /> As provided by Chapter 94,Oregon Laws 2024(SB 1545) <br /> Comments <br /> Instructions: <br /> •Attestation forms must be filed with the county assessor. <br /> •Contact your county assessor with questions on how or when to file the attestation. <br /> •Additional information about this special assessment program can be found on Form OR-C-RHSA Instructions, 150-303-007-1. <br /> Filed with the �1/l[,�/�i9'�/l NIA7 7 ./ County Assessor for the tax year beginning July 1,20 2 5 <br /> Part A—Description of homestead(please print or"type) _ -__ _ -— <br /> Fill in the boxes below to show the property you want to have specially assessed under the rebuilt homestead program. <br /> Property tax account number Map,tax lot,or parcel number Homestead situs(physical address) <br /> Part B—Written attestation <br /> SB 1545 Section 1 (9)states"Eligible property shall be assessed and taxed as other property similarlysituated is <br /> beginning with the property tax year that immediately succeeds the earliest of: p assessed and taxed <br /> (a) The date on which the rebuilt homestead is no longer occupied by the owner as a homestead,except when the owner is <br /> required to be absent by reason of health or active military service; <br /> (b) The date on which the rebuilt homestead is rented to another person for any duration;or <br /> (c) The date on which the rebuilt homestead is transferred to new ownership." <br /> SB 1545 Section 1 (7)(b)states"For each subsequent property tax year for which the specially assessed value is claimed,the owner <br /> of the rebuilt homestead must file an attestation, under penalties for false swearing,that the owner will continue to occupy the rebuilt <br /> homestead as <br /> 9 V the owner's� principal� dwelling for the entirety of the property tax year." <br /> I(owner) I / Pf144 ✓V'-i-f i7V1/ li (please print)indicate by my signature I will continue <br /> to occupy the rebuilt homestead as my principal dwelling for the entirety of the property tax year.As owner of the above-described <br /> property, I acknowledge I understand the circumstances that may disqualify the property from special assessment and that I must _ <br /> file an attestation annually to continue the special assessment in the future. I declare under the penalties for false swearing[ORS <br /> 305.990(4)]that I have examined this document,and to the best of my knowledge, it is true,correct,and complete. <br /> Sign Applicant ignature1 <br /> here Date <br /> X / '- i l o ZzS- <br />