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t 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 /44✓n IAS' Iris PA-t-r ci A 6/0-3 --- ` � z, e Mailing adds Email(optional) 4410 1Z3i 12(25P_ Sr-- AJ it) City State ZIP code ig-W1 • ale '9. 730 9 Location and description of damaged or destroyed property Assessor's account number 14 4 //t ss �' S4 ( '5C a7 0q 31 a�iaz Location of property(if different from above)• Section SII/,M. Township Range Tax lot number o GPres EJ i)i ids i 3 i©C. 6A T-es t'-+i I I rz 1 si_, 27 T-15 83E GA-re5 O93EZ.1tsccaic 'Description of personal property 6 6-47-es Mi 1I Rd, GA rrs r or- 9.73 1/6 1142A.St 5¢4- A44A-tc-4 ittilit P54.. /. cr s Date of damage Cause of damage Air 7— ? ❑Fire(attach fire department report) ❑Act of God(describe): il-PG-t-B Damage occurred to . Land R-Building ,Personal property 'Manufactured structure Describe damage GA76.1 CV'. 14-);aAfr, -s — AL Less 4..Lvte'ry`71,+"µ5 cy.1..7e.— Asii-a-- d Rubbig--l4FoMc-2 44 Sit rra u r�d�rr3 495r�°51-1�/ 5 C3v►t' d� SZ.on td�1v5'i`Z r"(9e!L,C �cc, �c oD fis r3 u.,. �a t Application for proration of tax 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 pity is only d 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 th uty talc e and finalize the tax proration. _ N =O� wCID U� ClZ LU Declaration Lii W I declare under the penalties for false swearing[ORS 305.990(4)]that I have examined this document and to the best Crmy knowlet§e it is true,correct,and complete. X o.c^� ,' 7 ,„ 8) - .20 2 0 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. Clerk: 04 sVv Damaged property: This year Land and improvements: Real market value(RMV)before RMV after } Date rebuild complete: Months prorated: fire/act of God: 97Z[ci! 73 2fire/act of God: / Assessed value(AV)before l(! Value p/�� Amount of adjustment/refund: ----- fire/act of God: /a 9 776 percent of loss: 0,Q 6, 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/e — 12.57.2 6, fire/act of God: percent of loss: Remarks: h Date property visited: J •Jto 2(J ID Damaged C�estroyed US i Vrrl €61 150-310-083(Rev.12-15)