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t. , Application for Proration of Property Taxes RCVS& Due to Damage by Fire or Act of God Date received Oregon Revised Statutes(ORS)308.425 DEC 31 2020 Instructions: •Application for proration of property taxes may be made for the tax year of the property damage/destruction.If approved( Maiicrrtount of tax due or result in a tax refund.The tax year is from July 1 to June 30. AShvDSSOR •Your application must be filed within 60 days of the damage or by June 30 of the tax year in which the damage occurred,w lc ever is later. •File your application with the county tax collector of the county in which your damaged property is located. Applicant's nam Phone can-fit Ak. 6e(t 503 q30-6203 Mailing addre s Email(opti nal) 2,X,8-d l Tenet- Pi(. Ike ormatt.ectm, City State ZIP code 1,1 dri.s o R 2735 3 Location and description of damaged or destroyed property Assessor's account number R41200 / 541200 Location of property(if different from above) Section Township Range Tax lot number 18DA 09S 2E -see -73 pertyi (4045 .1 iieeeic. Lyons, OR 97358 Description4.cpof personal boa`s) 41 fe Date of dam a Cause of damage fig 020 Per) Wire(attach fire department report) El Act of God (describe): Da age ccurred to 11-Land Uilding Personal property ❑Manufactured structure Describe pdamage (oaks Bea 1._ 4-ree5 bartid, Application for proration of tax jg(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 the penalties for false swearing [ORS 305.990(4)]that I have examined this document and to the best of my knowledge it is true,correct, d complete. X r , Applicant's signature Date —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: 2-23-21 Clerk: fr Date received: '-'j/21 Clerk: hi V 0 co Damaged property: This year Land and improvements: Date rebuild complete: �� Months ror Real market value(RMV)before RMV after P P l fire/act of God: 1-16 550 fire/act of God: 3145oo KOUS �j��TO VALt v��'�-[ Assessed value(AV)�befo�reL Value rn►}rafca tali a 0�l fire/act of God: 2+�►.�'i6 percent of loss: 6 Destroyed pro err O•t 1 NGG 1%, '�}F1/�� This year Personal property: N `11�• RMV Months prorated: fire/act of God: RMV after ire ac ofGod: AV before Value Amount of adjustment/refund: fire/act of God: percent of loss: Remarks: Date property visited: /....4,24 1=I Damaged Destroyed QjnAL Ce/Yi)rn141 150-310-083(Rev.12-15)