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Application for Proration of Property Taxes For county use only 1 Due to Damage by Fire or Act of God °a+ "`` °'d 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 Hume Phone 7om1$ IC: L ur►o,1S 5-03_ 93 (0-71iZ- Mailing address Email(optional) 3:5-'3 :L.S e STH gT, '-kho,w..-®,,-Gy 4,..„,„. City State ZIP code DR, g73S6 Location and description of damaged or destroyed property Assessor's account number s &S / xr .5"9i Location of property(if different rom above} Section Township 1 Range Tax lot number 3•2 •827 0 e5 I yE' plASI>0 Description of personal property Date of damage I Cause of damage ��// // 9- 7-2oz o ❑Fire(attach fire department report) l✓1Act of God(describe): 4eAt-L41 eitit/'€._ Dammaa occurred L"1 Land If Building t'JPersonal property Li Manufactured structure Describe damage ' r — — • W c Z0 00 Lin �/ Application for proration of tax L!!cq z Ldt I am applying to have the above property examined for proration of property taxes per ORS 308.425.Application mustb3sultittedTIT within 60 days of damage or June 30,whichever is later. c1 4f Whether my property is damaged or destroyed will be determined by the County Assessor's office.If the assessor determines my properly Tis only dam- 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 duty to calculate 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. X .2 .0.—____71-7Z.-.0.4••"--- _ q-- i', w t.o Applicant's signature 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: fib./a,. 2..0 Clerk: tfi?Z, `rCw Damaged property: This year Land and improvements: �I. „,....--•' Real market value(RRA before RMV after �y Date rebuild complete: Months prorated: fire/act of God: 3" -770 fire/act of God: I 13...20 Assessed value(AV)before Value t� Amount of adjustment/refund:I _1 fire/act of God: I i' `-i() _ percent of loss: 0• oi Destroyed property: r7 This year Personal property: gMonths prorated:_. RMV before RMV after — fireiact of God:__._. fire/act of God: -36Vlue 4'6i pence TM Amount of adjustmenV364d:( + AV before fire/act of God:- _ percent of loss Remarks: Date property visited: /6 •J - 2.0 0 Damaged stroyed 05P c a$c\_ 00 150-310-083(Rei 12-15) ... ---- --- ----