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DigiSign Verified:EF8D6827-572B-4410-998B-OADB73139303 <br /> • <br /> Board of Property Tax Appeals For official use only <br /> Petition number and date received <br /> Real Property Petition <br /> for Marion County 20-027 <br /> •Read all instructions carefully before completing this forth. <br /> •Please print or type the requested information on both sides of this petition. <br /> •Complete one petition form for each account you're appealing. <br /> •Return your completed petitions)to the address shown on the back. <br /> •Use this form for manufactured structures,not the Personal Property Petition. <br /> •Include a copy of your tax statement. <br /> Petitioner(person in whose name petition is filed) <br /> 1 clack the box that swim 0 owner. <br /> ...1 Person or business,other than owner,obligated to pay taxes(attach proof of obligation). <br /> 2 Nam.—I ndivrdu I,corporation,or other business 3 Email address(optional) <br /> John A.Stall stonystailG'yahoo.com <br /> 4 Phone number <br /> Daytime No Phone !Evening <br /> 6 Main g address(street or PO Bo:) <br /> o/c 735 Commercial St SE m <br /> 6 City 7 Stat. 8 ZIP cod. 0 <br /> Salem OR 97301co <br /> sees P <br /> For 9 Name of person acting for corporation,LW,or other business 10 TNI.(for example,president,vice president,tax manager,etc.) <br /> business <br /> we billy J CO <br /> N a representative Is named on Nne 11,all correspondence regarding this petition will be mailed or delivered to the repres tative. <br /> Representative} Complete this section when the petition is signed by an authorized representative of petitioner.Only certain <br /> people qualify to act as an authorized representative.See the instructions for a list of who qualifies. <br /> 11 Name of representative 12 Entail address(optional) <br /> Gladys Blum giadys@blumre.com • <br /> • <br /> 18 Phone number <br /> Daytime 503-485-1900 !Evening 503-507-6225 <br /> 14 Mailing address(street or PO Box) <br /> 735 Commercial ST SE <br /> 15 City 16 State 17 ZIP cod. <br /> Salem OR 97301 <br /> 18 Paptlonsltp to petitioner named on line 2 <br /> Real Estate Broker . <br /> 19 Oregon sats bar number 20 Oregon appraiser license number 21 Oregon broker kens.number 22 Oregon CPA or PA permit or S.E.A.number <br /> 781200091 <br /> Any refund resulting from this appeal will be made payable to the petitioner named on line 2 unless separate written authorization is made to <br /> the county tax collector.However,If a representative is designated,any refund will be sent to this individual or business,not the petitioner. <br /> •_-_ .. __ —_.__ sees_-- __ . <br /> Attendance at hearing <br /> "WIN you or your designated representative attend the hearing? ®Yes D No <br /> If you choose not to be present at the hearing,BOPTA will make a decision based on the written evidence you submit. <br /> Property information <br /> 24 Assessor's account number(from your tax statement) 25 Assessor's map and tax lot number(ram your tax statement) <br /> R31585 083W06DB00800 <br /> 25 Street address and city where property Is toasted 27 Property type pi Residential n Commercial n Form <br /> 3786 Riverdale Rd S Salem,OR 97302 Q Mfd structure <br /> nMutts-family n Forest 0 Industrial <br /> 150410.061 OW.05-17) Please turn over—form continues on back��� <br />