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( • Application for Proration of Property Taxes For E lYr, D Due to Damage by Fire or Act of God Date received Oregon Revised Statutes(ORS)308.425 SEP 2 8 2020 Instructions: •Application for proration of property taxes may be made for the tax year of the property damage/destruction.If approved,this rompagtop tbeimplyt of tax due or result in a tax refund.The tax year is from July 1 to June 30. �AX 001 I TOR •Your application must be filed within 60 days of the damage or by June 30 of the tax year in which the damage occurred,w ichever rs er. •File your application with the county tax collector of the county in which your damaged property is located. Applicant's name M 1.cSr € € Ev� s Phone/��` s�'-1Z 881- C6 Mailing address Email((ooptionJ\al) • 4 l4 0 9 ger LcdS prtt \C Tow.9, City 0 ^� State ZIP code C�U(ca, 1 p•R q 1502-- Location and description of damaged or destroyed property Assessor's account number--Rseci Location of property('rf different from above) SecWn Township Range Tax lot number a'SD o� gifE OZ7a) Description of personal property Date of damage ?Nse of damage 9 fa—2.02_0 Fire(attac fire department partm_ ent report) 0 Act of God(describe): Damage occurred to «N Land 0 Building 0 Personal property 0 Manufactured structure ascribe damage Application for proration of tax ISI 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 c r q— a0-a O�c) 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: (-28--1,0 Clerk: /' Date received: 1 p •1 3•20 �b l0 V Clerk: Damaged property: This year Land and improvements: Real market value(RMV)before RMV after Date rebuild complete: Months prorated: fire/act of God: —72fire/act of God: /13330 , T,OVALUEONLY ( V)�3re�� Assessed value A bef re Value fire/act of God: �1a percent of loss: Destroyed property: NO CHi�NGE TO TAX A RMV beforepersonal ropePADOSRMV 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: 0 Damaged 0 Destroyed tnw lin(Ar 150-310-083(Rev.12-15)