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Application for Proration of Property Taxes nor c un use on(y 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,ttlIAt> $'R16unt of tax due or result in a tax refund.The tax year is from July'I 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 ♦ l . � y `J e am ) laa—eS9 2- Mailing ad/dr�ess ^y) • Email(optionaI))Q] (/C��J/tV1n�. .(\�' ,.(,)1 City .J OAR 97 30Z Location and description of damaged or destroyed property Assessor's account number -R9B(00(± Location of property(if different from above) Section Township Range Tax lot number 5a 64- o8 V6 ad700 Description of personal property Date of damage7a of damage —Qy-�OaO irettach fireddepartment r rt) 0 Act of God(describe): Damage occurred to je1ACI aC . 'Land 0 Building 0 Personal property 0 Manufactured structure Describe damage e`'-' \ u� e, ( iir......c_ 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 -. SUrc 9-a0-0.oa0 Applicants signature Date —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: q,-Ut `) Clerk: /7/ Date received: /0• /3•2O Clerk: N ]/ 66 Damaged property: This year Land and improvements: Real market value RMV)before RMV after 350�� Date rebuild complete: Months prorated: ��QN�Y fire/act of God: /t) fire/act of God: Assessed value(A before Value AS T V . raiellr Personal fire/act props i 80 percent of loss: Destroyed ProPerty� CHANGE NO CHHt,M G prorated:hs RMV before RMV after fire/act of God: fire/act of God: AV before Value Amount of adjustment/refund: fire/act of God: percent of loss: Remarks: Iti Date property visited: ❑Damaged ❑Destroyed 150-310-083(Rev.12-15)