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• Application for Proration of Property Taxes For county use only Due to Damage by Fire or Act of God Date received Oregon Revised Statutes(ORS)308.425 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 Phone , e..c1 and &e. Tumme,l 503-cm-5213 Mailing address Email(optional) Po Box 3L -trumwtei 92 e9mai1.cont City State ZIP code (SuibLI'wti41 og 47385 Location and description of damaged or destroyed property Assessor's account number Z L({ 34x483 Location of property(if different from above) Section Township Range Tax lot number 11055 rDO3wO0.c L&ie 18 A- 44'1 3 C oo i Ov Description of personal property LIONS CA in 3s 8 Date of damage Cause of damage . , 9-8-20 0 Fire(attach fire department report) ty' 'Act of God (describe): WI Id-1r . Damage occurred to Land Building %Personal property 0 Manufactured structure Describe damage Our home, aYld eve.rc�.f.hi n� inside -t5 cornplek 1056. I e -k oke ro"�j-VIA 4-re:es3 wit( ne.e A ihsPedir 40 v?-r( 14661'4 car=6 Application for proration of tax N Z O L I am applying to have the above property examined for proration of property taxes per ORS 308.425.Application must t ubnaed 5 2 f within 60 days of damage or June 30,whichever is later. W — Z cnui Whether my property is damaged or destroyed will be determined by the County Assessor's office.If the assessor determines my prope ' only Oram- '=-:„. Q 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 du cal ite Q and finalize the tax proration. Declaration I declare under the penalties for false swearing[ORS 305.990(4)]that I have examined this document and to the best of my knowledge it is true,correct,and complete. Applicant's signatu Date —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: Clerk: Date received: I 0-6.a) Clerk: 44 Ma (,v t f Damaged property: This year Land and improvements: Real market value(RMV)bef RMV after p �.1 Date rebuild complete: Months prorated: fire/act of God: zq ,�() fire/act of God: D + V Assessed value(Aube orre Value 0, 5'505 Amount of adjustment/fgfund: fire/act of God: percent of loss: Destroyed property: ' This year Personal property: Months prorated: RMV before RMV after fire/act of God: fire/act of God: AV before Value Amount efadjustment/4ml: —IOQ'j'7Z fire/act of God: percent of loss: Remarks: Date property visited:Ad -{,.,21) 'Damaged 0 Destroyed of-,F '1 rr Atci ivt! 150-310-083(Rev.12-15)