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FOR ASSESSOR'S USE ONELY <br /> CEIVED <br /> Form OR-C-RHSA-2 Date 1Received <br /> Page 1 of 1,150-303-009 Oregon Department of Revenue ❑ Approved LI Denied APR 0 2025 <br /> (Rev.07-26-24) <br /> Date: By: MARION COUNTY <br /> Attestation for Continued Qualification of Rebuilt ASShSSUR <br /> Homestead Special Assessment Currently Specially Assessed? n 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 Marion County Assessor for the tax year beginning July 1,2025 , <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 /> 22846 Jennie Road SE <br /> 541057 092E18AD00700 Lyons,OR 97358 <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 /> I(owner) Lorraine K Cozby (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 1 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 signature Date <br /> here Ir <br /> X - ^ � 04 01 2025 <br /> RECEIVED <br /> APR 0 1 2025 <br /> MARION COUNTY <br /> ASSESSOR <br />