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RFCEIVFD Application for Proration of Property Taxes For county use only Due to Damage by Fire or Act of God Date received 8 Oregon Revised Statutes(ORS)308.425 SEP 2 2020 Instructions: •Application for proration of property taxes may be made for the tax year of the property damage/destruction.If approved,thiiMPalc9relUlgaint of tax due or result in a tax refund.The tax year is from July 1 to June 30. TAX 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 ,/\x/1` C\j ^ �e Phone �( Medina address �1 \ csb et' -s J r 4(0 o9 �` 1 ALX te EP r UnGGc 1�w9 ,ulf�I City Sate ZIP e Co J Location and description of damaged or destroyed property Assessor's account number "KS8602__ ` 58(e0 Location of property(if different front above) s00906 ✓i/ Township_ Rang Tax lot number Description of personal property Date of damage Cause of damage 9,.-•g.— o Ytire attach fire department report) 0 Act of God(describe): D age occurred to �� nd 0 Building 0 Personal property 0 Manufactured structure ribe damage T - (A-y, toy -Whe_ .. s- -e 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 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 Q� ci— ao—aoao 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: 4'2_8-20 Clerk: /$" Date received: /0 .j 3. 20 Clerk: g(Q A.) Damaged property: This year Land and improvements: Real market value RMV)before RMV after Date rebuild complete: Months prorated:�, _ 0 . `Y fire/act of God: 3 fire/act of God: 53890 NTTO"' Assessed value to befo Value A GE d .4 = OU year Personal tf property: D percent of loss: 0 Destroyed property:No CThis leo 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: I Date property visited: ElDamaged 0 Destroyed 150-310-083(Rev.12-15)