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• RECEIVED 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 SEP 2 8 2020 Instructions: �l��nn1�cr� •Application for proration of property taxes may be made for the tax year of the property damage/destruction.If approved,this r tr±t7dt�ttte' iYt of tax due or result in a tax refund.The tax year is from July 7 to June 30. T COLLECTOR •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 AA.l d4�e- YPne i.r_kir) (533) 881 -----' 3S9 2__ 451 Q9 et-CC-ULA l 'ifk.CP 1.-JarNe... , ,,,,,,,,&\E.,,,,,„:„Ac,.wiy) Email(optional). City ��(� /�(� Stat ZIP code .amu I qi"a02.- Location and description of damaged or destroyed property Assessor's account number 6 5t,(4,c1) CO Location of property(if different from above) Section �� Township Range � Tax lot number of/OO Description of personal property Date of damagea of damage 9-r8—�.O acs Eir (attach fire depart ent repo ) ❑Act of God(describe): Damage occurred to 1 Land 0 Building 0 Personal property ❑Manufactured structure Describe damage�� biLivica Application for proration of tax am applying to have the above property examined for proration of property taxes per ORS 308.425.Application must be submitted ithin 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 s CL ,& :.s-) 9-ao-Qoac, Appli signature Date —Applicant will be notified of the county's decision— For tax collector's use ony For assessor's use only Date received: r 2)6`'1,(j Clerk:tli Date received: j 0.13.20 Clerk: &o, &la Damaged property: This year Land and improvements: Date rebuild complete: Months prorated: Real market value(RM before RMV after O 1:'1 1C ONLY fire/act of God: o'7/CO fire/act of God: a — y' 1.r`V Assessed value(AV)before _ Value Ar mount of adjilstment/refuo • WNW O �Nt fire/act of God: 7a y 1) percent of loss: 0 Destroyed propel t, , '' ) ',` This year Personal property: tst'' m RMV before RMV after Months prorated: 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 / 471 150-310-083(Rev.12-15)