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Application for Proration of Property Taxes �r�• � 1 Due to Damage by Fire or Act of God Date received Oregon Revised Statutes(ORS)308.425 EP ; 2020 Instructions: •Application for proration of property taxes may be made for the tax year of the property damage/destruction.If approved,thimme*Woirriyunt of tax due or result in a tax refund.The tax year is from July'I to June 30. p�r,��F� q •Your application must be filed within 60 days of the damage or by June 30 of the tax year in which the damage occurredTWhSct�ifi'13'1TRf•.' •File your application with the county tax collector of the county in which your damaged property is located. Applicant's name [ Phone(\/ k Ae_ __).� (� s ) VQVI—aS Z Mailing address 14A0 CR arc cr Las : Email(optional)) prtn�Z aQ e, ,wm City oe- cri302 Location and description of damaged or destroyed property Assessor's account number Rs(3 Gos sSs- Location of property(if different from above) n Township Range Tax lot number _ a as p Description of personal property Date of damage Cause of damage 9,—(2)—�0a,tj XFir attach fire department r port) 0 Act of God(describe): Damage occurred to 1Cei Cr .and 0 Building 0 Personal property 0 Manufactured structure cnbe damage 1, 4 Application for proration of tax )11rapplying to have the above property examined for proration of property taxes per ORS 308.425.Application must be submitted wartlhin 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 —5 6CC&CC(.)CeM 9—ao-ao acs 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: ZG Clerk: /7f Date received: /p •/3 • j Clerk: iv`OC Damaged property: This year Land and improvements:Real �[[�!/,rl fire/act God:ket value(RMV)before RMV vftofrGod: 17 7 7(/ Date rebuild complete: Months prorated: 0?‘,/yyo Assessed value(AV)beIo 5�D Value Amount of adjustment/refund: fire/act of God: percent of loss: e) Destroyed property: This year Personal property: 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: lard Date property visited: ❑Damaged ❑Destroyed a4/ 150-310-083(Rev.12-15)