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Request for Appraisal Review Office Use Only <br /> Log#: 121 - 0516 <br /> Taxpayer please fill out this side only <br /> Date: <br /> Filing Deadline is the first Friday in December by: �d,�g #9.y <br /> Taken <br /> Please use separate review sheets for each account <br /> res. ;:f9/ }}�� <br /> Date: 1'y/I/y� r 1r,{ <br /> f;� <br /> Have you appealed to the Board of Property Tax Appeals?: ('Yes C./No <br /> Review Requested By(if different than property owner): <br /> f �"' , '1 , oo1r Ain p <br /> Owner Name: 1)(400 call ry ok Email: elpk 't5(Y14GC pth Phone: .20(.0 -D4I-73t <br /> Owner Mailing Address(complete address): <br /> 1255 terve Sl-rl✓et-, lJ nif I3o) S`I L,rertb-n l Dl2 95 I <br /> Street Address of Property for Review: two p a(67 g7U ,i+s/--(,. City: <br /> Map/raxlot#: DbI�J 3SpC g '7 <br /> OoIS Act x'91 No.:� 6� / C / <br /> Real Market Value Requested:l ([ j <br /> Land: Structures: 3OjeepJLTotal: 3 V(Gfla1", <br /> additional information and documentation supporting your requested value.Attach additional documents if ecessary. <br /> Please prove=............. l/ /1 � `� <br /> Nly kOUSe. fI filar-61 4o a LP Cost <br /> Ii 384 °oz . oo <br /> lekornyre1 rtim wbf SO-re t,,9 ` -an 5t�at J t / <br /> cwke Vj-44 rn� tr39°I1 °� - 155(p , R7 --safccyl, <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 /> httpd/www.co.marion.or.us/CO/Pages/bopta.aspx <br />