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{ Board of Property Tax Appeals For official us.only Petition number and date received Real Property Petition t for pt A(.%o >\) County 20_026 •Read all Instructions carefully before completing this form. •Please print or type the requested information on both sides of this petition. •Complete one petition form for each account you're appealing. •Return your completed petition(s)to the address shown on the back. •Use this form for manufactured structures,not the Personal Property Petition. •Include a copy of your tax statement Petitioner(person In whose name petition is hied) 1 Check the box that applies: FOwner. Person or business,other than owner,obligated to pay taxes(attach proof of obligation). 2 Name—individual,corporation,or other business 3 Email address(optional) Apo3Tot.s c [Flints ri!►•1 Eikrr c p 5J1n-twwivrorJ 4 Phone number DaYlinte 50 3-'5 - .92sq I Evening 503 -ss?.- g Z3q 5 Mailing address(street or PO Box) 6 City 7 State 8 ZIP code 5 t.fNttTY O 9739 For 9 Name of person acting for corporation,LLC,or other business 10 Title(for example,president,vice president,tax manager,etc.) business oftlY} J A.4AES 1) -r R.l G —1-12iciSo 2Ef2.. If a representative is named on line 11,all correspondence regarding this petition will be mailed or delivered to the representative. Representative 1 Complete this section when the petition is signed by an authorized representative of petitioner.Only certain J people qualify to act as an authorized representative.See the instructions for a list of who qualifies. 11 Name of representative 12 Email address(optional) 13 Phone number Daytime IEvening 14 Mailing address(street or PO Box) 15 City 16 State 17 ZIP code i ; 18 Relationship to petitioner named on line 2 7 • 19 Oregon state bar number 20 Oregon appraiser license number 21 Oregon broker license number 22 Oregon CPA or PA p or S.E.AI� Any refund resulting from this appeal will be made payable to the petitioner named on line 2 unless separate•written autlioon is mile to the county tax collector.However,if a representative is designated,any refund will be sent to this individual or businessapt the pepttpner. Attendance at hearing 23 wa you or your designated representative attend the hearing? C Yes 1410 If you choose not to be present at the hewing,BOPTA wall make a decision based on the written evidence you submit. Property information 24 Assessor's account number(from your tax statement) 25 Assessors map and tax lot number(from your tax statement) R4.31 5(a, o81vd19 C 02501 28 Street address and city where property Is located AA p 27 Property ripe r Residential JFarm Corsnercial r 6.L 91 FUER. 'RD SE, ums vt LLE,O ❑Mtd structure r Multi-faniy rI Forest r industrial 1e0-31o.0e3 elev.05-17) Please turn over—form continues on back��