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Request for Appraisal Review Office Use Only <br /> Logs: T21 -035 <br /> Taxpayer please Till out this side only <br /> Date: I I- t o - 2c141" <br /> Filing Deadline is the first Friday in December by: fy DA( <br /> ,� <br /> Taken f pt t <br /> Please use separate review sheets for each account <br /> Date: 11)1641 IWJ L7 <br /> Have you appealed to the Board of Property Tax Appeals?: r Yes C No <br /> Review Requested By(if different than property owner): 1'1��G.YU (, //�1 <br /> I I b�'18n <br /> Owner Name: <br /> Al Cloy;:Otl PO]] <br /> Email: MC11`YAnip P;tantOh5kvGf}xxI Phone: <br /> 6037130.0c115 <br /> (tityi«r . Alber,t) <br /> Owner Mailing Address(complete address): <br /> Vt14 c lolly Gn , W-lsxly;Il . , v/Z 91010 <br /> Street Address of Property for Review: City: IAA Lunn <br /> Map/laxlot#: os/1,116a,11.50E) Account No.: 359 q I l a <br /> 1/�j Real Market Value Requested: <br /> Land: 7✓ Structures: Total: <br /> Please provide addition/al information and documentation supporting your requested value.Attach additional documents if necessary. <br /> CoIrnynoln DAC\ 5koul tot non-faLSse55& dut h <br /> bein pct ' of tormnor Pnf&a, <br /> Please email completed forms to: assessor@co.marion.or.us <br /> You may also print and mail copies of completed forms to: <br /> Marion County Assessor <br /> P.O.Box 14500 <br /> Salem,OR 97309 <br /> THIS IS NOT AN APPEAL <br /> Please refer to appeal rights included with your tax statement. <br /> To file an appeal please visit: <br /> http://www.co.marion.or.us/CO/Pages/bopta.aspx <br />