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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 Lk r'\VC '- '\ 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 CW SPECIALTY,LUMBER(along with)COOPER WAGNER PROPERTIES LLC 5ho Mailing address 5033e-551-8933 PO BOX 1159 Email(optional) City chris@cwlumber.com Mill City State I ZIP code OR 97360 Location and description of damaged or destroyed property Assessor's account number • : , - :1 : -,. -.. - : -- - - : 111320 TZ(ll 3249 Location of property(if different from above) Section 27622 River Rd.SE Mill City 25 Township RangeETax lot number 09S (2E 1400 Description of personal property Date of damage Cause of damage 09/08120 0 Fire(attach fire department report) 2lAct of God(describe): 8eachje Creek Fire Damage occurred to 0 Land ©Building 0 Personal property 0 Manufactured structure Describe damage Entire operation destroyed by the fire.Including buildings, machinery,supplies and inventory. I Application for proration of tax ®l 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 rrect,and co tete. X Appli nt's signature -��t` f —070 Date —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: Z'S-Z( Cleric/`g Date received: alai/Zo Zp Clerk 'Z3--2.774:1-11Damaged property: This year Land and improvements: �* '� Date rebuild complete: -'— Months prorated: Real market value(R�t b fo RMV after QQ fire/act of God: %SVS X90 fire/act of God: 7 3, g490 Amount of adjustment/refund: Assessed value(AV) re Value pv€ ?o fire/act of God: [ /t bI O percent of loss: a /, J /o Destroyed properly This year Personal property: Months prorated: RMV before RMV after fire/act of God; fire/act of God: AV before Value Amount of adjustment/i ie; -"" 5-8 53.5? fire/act of God: percent of loss: Remarks: P 't 'j '` Date property visited: I2/?if?-BZ-19 0 Damaged PrXrestroyed 1 60-310-033)Rev.12-15)