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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 I- earQftc. E. (_NrS-Focfl RLI 6D 67? Y1-7 i Mailing address Email(optional) )382 SF IIC1 oR I115'roy @co ince,51;-i1 ( City M/ s State Q ZIP code 77 O/3 Location and description of damaged or destroyed property ,` J Assessor's account number Location of property(if different from above) Section Township Range Tax lot Rtiffiber MAp 013017 cg co yam diCi O&7 3E 00 00 Description of personal property CODE 12_ 9 V o 9i0 Date of damage Cause of damage 0 9- O -2 o L D Fire(attach fire department report) Act of God(describe): 'c.c�� Damage occurred to Land Building 0 Personal property 0 Manufactured structure Describe damage W N 0 SIT Clb/ Es s'TR Jy !1 FI }� W �, CD s QGi fJ Eb 0 o_ Q CC cW Application for proration of tax lli.l am applying to have the above property examined for proration of property taxes per ORS 308.425.Application must be submitted within 60 days of damage or June 30,whichever is later. Whether my property is damaged or destroyed will be determined by the County Assessor's office.If the assessor determines my property is 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 t E 0 9- / -2 02 o Applican' ignature Date —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: (-17?•21 Clerk: /r Date received: I O-14-24) Clerk: 44(fib (/4J Damaged property: This year Land and improvements: v Real mct o f Get value,d:6;e di 5 beQ RMV after Date rebuild complete: � Months prorated: ,NLl fire/act of God:�(��55-/ fire/act of God: 1 53(.96 �.n^,,,,`` TMENT ls UNI Assessed value V)before Value Pvddi f t. y• I year fire/ of 1 S-1 LoPersonpercent of loss: 6 property: HO RMV before RMV after Months prorated: fire/act of God: fire/act of God: AV before Value Amount of adjustment/refund: �i fire/act of God: percent of loss: Remarks: Date property visited: 1()"ICAO 0 Damaged (Destroyed it:5cwk. 150-310-083(Rev.12-15)