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Clear Form 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 I v' 3.--)_. )2C. .) 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 Kristopher Steven Amundson 503-970-5985 Mailing address Email(optional) 1513 Irving Ave. krisa@subtend.net City State ZIP code Astoria OR 97103 Location and description of damaged or destroyed property Assessor's account number R40904 ‘5c 0 T Location of property(if different from above) Section Township_ Ran Tax lotnumber 25557 Taylor Park Road SE 1 OM ��.'/�il) 7C_. ,3C(3 Lyons, OR 97358 Description of personal property Single Family Home Date of damage Cause of damage Wildfire- Beachie Creek Fire 09-08-2020 El Fire(attach fire department report) 0 Act of God(describe): Damage occurred to El Land ElBuilding 0 Personal property 0 Manufactured structure Describe damage Total loss of all structures due to Beachie Creek Fire. Application for proration of tax 1=11 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 10-05-2020 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: 11-23-10 Clerk: rte Date received: / _2 1,a(> Clerk: /4)v e Damaged property: This year Land and improvements: Real market value(RM4 before\ RMV after p ,� Date rebuild complete: Months prorated: fire/act of God: L-5 v fire/act of God:O�CJCXJ Assessed value(Ps\11 be re Value /y Amount of adjustment/refund: "� fire/act of God: L b i5‘5d percent of loss: d 4c/7791 Destroyed property: This year Personal property: RMV before RMV after Months prorated: 5 fire/act of God: fire/act of God: 65-q ,06 AV before Value Amount of adjustmen refund. fire/act of God:_ percent of loss: Remarks: , Date property visited:/0.- f' ..c2d 1:1Damaged troyed (, �,.� ,"tedi 150-310-083(Rev.12-15)