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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 1D-20 2 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 Ito 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'R,oprrV r ' W704 1 Phone 3_ 2�(c nayid L‘ T> Vr.. ) v, A .5e c-i l/usire�s 5--0.5_1_7.:8-4.i. 503-vim=I+ 1�1- . Mailing address Email(optional) Gp� 2Z to t L{-G�1,S��/ l`0.W1\\N r .- i - e-t. ��J t �� , A ` , .> e,b ��Nd t�Gam City I, I O VI�- State ZIP code L7 >p c2358 Location and description of damaged or destroyed property , Assessor's account number Location of property(if diff rent from above) Section Township Range Tax lot number Descriptio of personal property Ia?i 2.0\�n4 t)Int a41'avI -i Ino,c�iold.{�Y'v�i,(�.h�1 ori Date of damage Cause damage Ur i �S4 Y e,. `��`�, V` • Sept,z3 -7-b7 ) Vire(attach ire department report) ❑Act of God(describe): Dame a occurred to/ 'l _� Land wilding (Id"Personal property 0 Manufactured structure Describe damage , S(no? N t )(�u, (jl4¢*GLLA a. e 0-D vl-�Ck,� V,f Y19 0 0e-6a/re)/ ) aiy)e1,- Ilia vi I� .w PRe- c,0 m l i L .dei o y .)-'av,-115 �� Application for proration of tax ` lam 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 dat@ that the damage is repaired.Such notice will serve to inform the tax collector of their duty to calculate, and finalize the tax proration. • . I • • Declaration I declare under ie pen. '-- .r false sweating[ORS 305.990(4)]that I have examined this document and to the best of my knowledge DU:- cor :•t, •. d(� i e. �ti l ''w' -.1a0. 1 .0•--/-i ., :�. " .2-1. 4, ,,, 2,62-k L6 a)Ap,.lcan'sgnature NEI _. 0/1 Date —i *licant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: -2-3-2 i Cleric 1`f Date received: ", )b.2j Cleric VUR b 0 Damaged property: This year Land and Improvements: Date rebuild complete: '— Months prorated: ...----^ Real market value(RMV)before RMV after 11 II�,,f[0 A�,,'� E TO VNLY fire/act of God: N c4 0 fire/act of God: 77 ��(L�� Assessed of valueo : (AV)befo Value l F 'e�N� MOUNT fire/act God: b percent of loss: V Destroyed property: NO CHANGEThis year Personal property: Months prorated: ..•--, RMV before RMV after fire/act of God: fire/act of God: AV before Value Amount of adjustment/refund: `" fire/act of God: percent of loss: . Remarks: _ / G.( Date property visited: 0 Damaged 0 Destroyed I (//jU/1((�i{t 150-310-083(Rev.12-15) •