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/ . p fivic42,0 Application for Proration'of Property Taxes For county use only Due to Damage by Fire or Act of God Dale received \ Oregon Revised Statutes(ORS)308.425 I C>2f�--2t ) 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'G2.es,0� ` 1 Phone Ak4c n6;Yid C, 'g7 :_.:q . `�—AWW V( Ci, . xeie f }Yl?s' S 663.5 — 3 \ft Mailing address a/ r Email(optional),(,b�`M �N(1/��I,L�plfn --z(Dt`i-'NiSe0Nr1aiM Wyr , 4 ,/ , r i> �b ev�dt„Gorn City 9 t Q� Statede (2 ZIP cif/35-g FiLocation and description of damaged or destroyed property Assessor's account number Location of property(rf d' rent from above) Section Township Range Tax lot number Descriptionvcy of personal property _(- le 1.." Date of damage Cause damage;. ljt� tJ 11�(�`ye„ fJ�i\ f . 5evt-' styz, Ire(attach re d p rrtment report) ❑Act ofUo`d(describe): Dania occurred to/ �� Land wilding lla'Personal property 0 Manufactured structure Describe damage % lai .`� I a:.&h d a111÷ClA 0-f yl o 0e, a/ iud re)/[OOP d e- loo i VV .W e- c.om l� iy .a. o ed'a63,113, aA 14,1„gty Low- - -vk • �� Application for proration of tax • ` 1. 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%ie pen- - •r false swearing[ORS 305.990(4)]that I have examined this document and to the best of my knowledge tru- cor :st, dci 1• - e. All,' 0�_I 2 ..�''l i : e . ,-• '' ' 2h L6 Zro Ap•i can--s gnature iiiiIMEMMOMIBMINIrilr Date —' ,*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 s! Clerk:tr Date received: I'. I 0 • 2L.) Clerk: INV b 1 Damaged property: • This year Land and Improvements: Date rebuild complete: ,• Months prorated: Real market value(RMV)before RMV after ,.C,M '' Y ONt ( fire/act of God: (pI.,,O fire/act of God: (p GO AD iUQT NT JN•T Assessed of valueo : (AV)beforeValuec0 NO CHANGE,� ofire/act of God: �Q percent of loss: I Destroyed property: This 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: V Date property visited: 0 Damaged 0 Destroyed (/JlU/�fJI� h 150-310-083(Rev 12-15) •