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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; •Applicaton 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 Jack kosma and Kathryn Murphy Phone 2312822098 Mailing address Email(optional) 11380 Schackman Lane se kem433@gmail.com City Stayton State ZIP code OR 97383 Location and description of damaged or destroyed property Assessor's account number 541242 (not sure its this number but no other number on the sight ,' L'Zq l 2({_� �y .�')[) Location of property(f different from above) [/t�✓v- Section n Township O? Rangel Tax lot number 25225 santiam park rd C� marion Description of personal property forest fire complete destruction of home Date of damage Cause of damage beechie creek fire 9/9/20 0 Fire(attach fire department report) El Act of God(describe): Damage occurred to O Land 0 Building 0 Personal property 0 Manufactured structure Describe damage Home and garage totally burned. Trees and shrubs gone ci z cc 7C.4 Ochi) oID U U) Application for proration of tax W f]I am applying to have the above property examined for proration of property taxes per ORS 308.425.Applicatioust 4 sutlitfsa 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 operty 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)j that I have examined this document and to the best of my knowledge it is true,correct,and complete. X 41,1!".- C7201 2-` APO .r Date —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Don e�ed: C Date received: em ,/3.07 O Clerk: rek, This year Land and itnpro Date rebuild complete: Months prorated: _—� Real market value M before RMV after '1 fire/act of God: I I0 fire/act of God: Ica I 1 V �_ Assessed value(A ore Value Amount of.adjustment/refund: fire/act of God: 0��('s percent of loss: 0/ Q Destroyed Property. This year Personal property; 'Months prorated: RMV before RMV after fire/act of God: fire/act of God: AV before Value Amount of adjustment/ttaat* — 1 y y fire/act of God: percent of loss: Remarks: i✓�� tite-r&i Date property visited: .1147_,1?".."_ 0 Damaged J21Destroyed 150-310-083(Rev.12-15)