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Application for Proration of Property Taxes For county use only Due to Damage by Fire or Act of God °ateed 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 MAgr-IAL• NN VIi)soy--‘ Sal-3(07- I 35 X Mailing address 1 POe_AA? re,,,,S loin .1-0 1 E Email(optional) 92,94 MuisrANci V A.y w\w‘lson 14039C1nnci(t,Cowt City State ZIP code A 16 ow -Al t./ ) lirAt 4 gli 005 CPE ci__1_3__g Location and description of damaged or destroyed property Assessor's account number O1y b i \\ B <c-11 E C 2 E E " iia E -.-1.-t I,1( t 5 q o a I Location of property(if different from above) /� � /,,�1 � Section�� Township � Range � Tax lot number as5-3L emote- P l r•to.{lQrn , // Q/�f C Description of personal property Lyb-yl. O r q i . 5-6i 1-4ok,s� 6c,„�� e- S tuy an p�-t- Date of damage Cause of damage L`--4 ON \\ -EAC -"1 E _-K (/ G1 J 1-0-2.0 Wire(attach fire department report) 0 Act of God(describe): _. A As _. . r Damage occurred to rit Land It Building [111Dersonal property 0 Manufactured structure Describe damage fi .}.-Ai "• tct D f's-i-►2 tii. ri c,i,/ c e w\ ,SInoF GI'avagc. 1 c.cs-v‘>6( .1"-- -7,-. Application for proration of tax 0 XI am applying to have the above property examined for proration of property taxes per ORS 308.425.Application mine suttpittele it within 60 days of damage or June 30,whichever is later. > N p Whether my property is damaged or destroyed will be determined by the County Assessor's office.If the assessor determines my prc ty is Slay dark) CO 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 the(ty toTticulafd and finalize the tax proration. l u 0 Q cr to < 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 '1/U�o�r-t.�G 11, r h &I& 9 / 7� 'z02o 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: /0./3.ad Cleric to 60 Damaged property: This year Land and improvements: Date rebuild complete: Months prorated: — Real market value(RMV)before RMV after ,.�`` fire/act of God: fire/act of God:; V: Assessed value(AV)before Value Amount of adjustment/refund: �� fire/act of God: percent of loss: 0 ‘9 5 AI Destroyed property: n This year Personal property: RMV before RMV after Months prorated: fire/act of God: fire/act of God: AV before Value Amount of adjustment/retook `" ib •b 1 Q fire/act of God: percent of loss: Remarks: Date property visited: /0•!(a• ) 0 Damaged D,Destroyed OP/79 1/613.4)," 150-310-083(Rev.12-15) i i i I 1