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t -0 r'Y� Application for Proration of Property Taxes For county use only Due to Damage by Fire or Act of God Date received Oregon Revised Statutes(ORS)308.425 \ — 27- Instructions: 7 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 1 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 Phone Sarah Connally 503-409-6475 Mailing address Email(optional) 23784 Santiam Way SE wysaywhat@gmail.com City State ZIP code Lyons OR 97358 Location and description of damaged or destroyed property Assessor's account number 540993 Location of property(if different from above) Section Township Range Tax lot number Description of personal property Date of damage Cause of damage 09/08/2020 EIFire(attach fire department report) I Act of God (describe): Wildfire Damage occurred to 0 Land ID Building 0 Personal property ❑Manufactured structure Describe damage THe house and outbuildings have been completly destroyed by wildfire. The metal carport and garage are still standing. Application for proration of tax El I 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, and complete. X 3'aA,e C4W-01-12-, 01/27/2021 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: /4-V1-1i Clerk: /g Date received: 2 ?j Z t Clerk: it) 2 �o Damaged property: This year Land and improvements: Clerk: ( �� Date rebuild complete: "` Months r r Real market value(RMV)before RMV after j� p `s pr r — fire/act of God: Lin !I(O fire/act of God:p'ci�a(i 71 V 1 �►Tti T 10 AUL Assessed value(AV)before Value A V�rfi8Rh'rotrtrgtif fire/act of God: VIZ 110 6 �J j.N�1M� yr"_ percent of loss: Destroyed proq�rjx:cHp4GC 1 V This year Personal property: �►VRMV before RMV after Months prorated: — fire/act of God: fire/act of God: AV before Value Amount of adjustment/refund: fire/act of God: percent of to : Remarks: .. - Date property visited: 2-212( Damaged ❑Destroyed y owl/ 150-310-083(Rev.12-15)