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I 1 } C.,11 e_, Clear Form Application for Proration of Property Taxes For county use only Date received Due to Damage by Fire or Act of God - 77 � \ Oregon Revised Statutes(ORS)308.425 1 G-[7) �Cv 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 CIreq40-p 4- / - ,erns is-03) '13o - S-00,14Mailing address Email(optional) 35173 oaf l voa,.f Ave • o►hi titaciAms 'I P !nc-i-wic(ii-L,M, City State ZIP code ClOiLes b V-- 5734(0 Location and description of damaged or destroyed property Assessor's account number R41560 / 541560 Location of property(if different from above) Section Township Range Tax lot number 33873 Railroad Ave SE 25DD 09S 3E 700 Gates,OR 97346 Description of personal property 011611 r eihts Date of damage Cause ofdamage 1,1 Clint, ela r C C Y� r ` 1 /K/2 020 D Fire(attach fire department report) Act of God(describe): V)1\d�i fe, Damage occurred to ®Land la Building ®Personal property 0 Manufactured structure Describe damage fa-al foss o4 Coale , 9arle ave till 10e101911,1�c I rerseYlal rVper j Application for proration of tax RI I 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. j / .e1 - /4---441,--2Ck.)' adkoop.e__„ 01 45 Ito Appy.: sign-r,re Date —Applicant will be notified of the county's decision— For tax collector's use onr For assessor's use only Date received: 1-12.11 Cleric tif Date received: /6 -) '3. ZU Clerk: 4:1-4."d A>V Damaged property: This year Land and improvements: Date rebuild complete: Month Real market value(RMV)before RMV after `��rtO fO L fire/act of God: 3 L`O 7'W fire/act of God: 19 3 75c JUS f E u�ly w�/ ry` Assessed value(AVJ ore Value ! !V►AM fire/act of God:J _%51Q percent of loss: 40 DB9troyed property` NO��"� This year Personal property: Months prorated: RMV before RMV after fire/act of God: fire/act of God: 'AV before Value Amount of adjustment/refund: fire/act of God: percent of loss: Remarks: Date property visited: /b-16',e9C J 0 Damaged /Destroyed OS FPI FAMI rmuil 150-310-083(Rev.12-15)