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r DocuSi9n Envelope ID: 10CF0909-A50F-4FFA-8791-E17659CB7576 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 'Zq' ^ v Instructions: •Application for proration of property taxes may be made for the tax year of the property damage/destruction.If approved,this may reduce the amount of tax due or result in a tax refund.The tax year is from July 1 to June 30. •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 Phone Erik Blender,Ashley Collins, et al... 360-840-8744 Mailing address Email(optional) 2925 SE Brooklyn St. erikblender@gmail.com City State ZIP code Portland OR 97202 Location and description of damaged or destroyed property Assessor's account number R42110 43%:;),‘ I - Location of property(if different from above) Section Township Range Tax lot number 30 Devil's Creek Loop, Detroit, OR �k 3d 21 GC 9 7E /CPO 4 Description of personal property Improvements only- Forest Service Cabin & Det. Shed Date of damage Cause of damage Forest Fire-September 2020 Sept 8 - 10, 2020 0 Fire(attach fire department report) eAct of God(describe): Damage occurred to 0 Land C4 Building e Personal property ❑Manufactured structure Describe damage All cabins on the Devil's Creek Loop have been destroyed completely by the fire. 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. -DocuSigned by: X Ql..4t.d...t.� 09/28/2020 Applicant'sAQfl07n7signature»epern Date —Applicant will be notified of the county's decision— For tax collector's use only _ For assessor's use only Date received: i2.-I-10 Clerk: / Date received: I('�• 1 3.2+0 Clerk: ON 6 co Damaged property: This year Land and improvements: Date rebuild complete: � Monthsprorated: �� Real market value(RMV)before RMV after i) P fire/act of God: (42 0 fire/act of God: C/ Assessed value(A before Value /� Amount of adjustment/refund: fire/act of God: (0cip percent of loss: I. Destroyed property: This year Personal property:vv RMV before RMV after Months prorated: 9 fire/act of God: fire/act of God: �n �� AV before Value Amount of adjustmen efun L. fire/act of God: percent of loss: Remarks: Date property visited:VI•-i 2.0 0 Damaged pegCoyed U-8 PS 150-310-083(Rev.12-15)