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RECEIVED <br /> Form OR-C-RHSA-2 FOR ASSESSOR'S USE ONLY <br /> El rit Ncell 2025 <br /> Page 1 of 1,150-303-009 <br /> Oregon Department of Revenue Li Approved . HiV I / <br /> (Rev'07-26-24) <br /> MARION COUNTY <br /> Date: By: 64-SSEf'OP <br /> Attestation for Continued Qualification of Rebuilt <br /> Homestead Special Assessment <br /> As provided by Chapter 94,Oregon Laws 2024(SB 1545). currentlyspecianyAssessed7 ❑ Yes ❑ No <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 it/A 2,)Q f County Assessor for the tax year beginning July 1,20 < , <br /> Part A—Description of homestead(please print or type)_. <br /> Fiilih fhe 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 <br /> - Homestead situs(physical address) <br /> p <br /> Ma p aqz zzDOW0a <br /> 5 `.:23G MA c�1 2.5672 DEtWiTA vfE /°J <br /> Part B—Written attestation <br /> SB 1545 Section 1 (9)states"Eligible property shall be assessed and taxed as other property similarly situated is assessed and taxed <br /> beginning with the property tax year that immediately succeeds the earliest of: <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 the owner's principal dwelling for the entirety of the property tax year." <br /> (owner) DIZIU) D. R O'.i / I iz1` (s'a) <br /> to occupy the rebuilt homestead as.my (please print)indicate by my signature I will continue <br /> 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 ik Applicant signature. <br /> here irDate <br /> 2> <br /> 0i 0yiZ07s <br />