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• r <br /> Application for Proration of Property Taxes For d unt�l <br /> Due to Damage by Fire or Act of God Date received <br /> Oregon Revised Statutes(ORS)308.425 ., /_-__1:=2-C -2(..___I _2-QL( <br /> Instructions: <br /> *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 <br /> of tax due or result in a tax refund.The tax year is from July 1 to June 30. <br /> *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. <br /> *File your application with the county tax collector of the county in which your damaged property is located. <br /> cant's name <br /> ex"re 1 A r-S f.,+n Phone <br /> Mailaddress f'�r S. [ (4141- ZZ <br /> 'r7twJ (�� g"1 Email(optional) <br /> city L oc�5 1 b (oSA3ra e9m 1. (at <br /> tl2 k73 <br /> cdeLocation and description of dama ed or S <br /> Assessor's account number 9 destroyed property <br /> Sy 1p5 2--4`` S`f 093E3oC.A01401b <br /> Location <br /> Location <br /> er' �"p 4pv (if diff t from abo ) <br /> or ^S ,am H w Section Township jRane P �yx lot number <br /> Description of personal property <br /> /D+atte f da ma Cause of damage _/" t ��'A <br /> v � zilyo 0 Fire(attach fire department report) lid''Act of God(describe): ..314(..;H 1 ImorI + r <br /> Dam occurre,�d t�off•/lJ ) .041; t� <br /> and L1Vt3ilding 0 Personal property 0 Manufactured structure 0 <br /> Describe damage <br /> 1— <br /> ( ror� �mUY(1 b gr�lre 1+ / , 1 �� Ai <br /> ICY ' St'i <br /> 'e 'f i.�`��Voipr �ts1`Jx'� <br /> r ,t J4 <br /> , r :o' .I aPSIlv` <br /> Applic- ion for proration of tax <br /> am applying to have the above property examined for proration of property taxes per ORS 308.425.Application must be submitted <br /> within 60 days of damage or June 30,whichever is later. <br /> 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- <br /> 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 <br /> and finalize the tax proration. <br /> Declaration <br /> 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 <br /> it is t• . core and complete. <br /> t4111° <br /> App cant's signature 3 -A.Date <br /> —Applicant will be notified of the county's decision— <br /> For tax collector's use only <br /> Date received: '�" For assessor's use only <br /> 5-2.f Clerk:tr Date received: ^ O <br /> Damaged property: 2 2 Clerk: <br /> This year Land and improvements:Z( <br /> -, Real market value M�burg RMV after Q 1T4y <br /> Date rebuild complete: Months prorated: <br /> fire/act of God: t O fire/act of God: ( o <br /> Amount of adjustmenUrefund:I — Assessed value(A biofQore Value C� <br /> Destroyedproperty: fire/act of God: I 52p percent of Ioss:�' ��✓ <br /> y This year Personalro e <br /> / P P nY: <br /> Months prorated: RMV before RMV after <br /> fire/act of God: fire/act of God: <br /> AV before <br /> Amount of adjusttnenttAMM - 4 Q 1+b�l percent <br /> 0�7 fire/act of God: percent of loss: <br /> Remarks: Date property visited: 2-2-2'{ 0 Damaged stro ed <br /> 05P/X lgefitAtZ4014-"--- _ <br /> 150-310-083(Rev.12-15) <br /> i <br />