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Application for Proration of Property Taxes For county use only Date received Due to Damage by Fire or Act of God Oregon Revised Statutes(ORS)308.425 l;-(47- Instructions: r 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 amou 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 Christopher J Kirk&Lisa M Kirk 5038811147 Mailing address Email(optional) PO Box 148 chriskirk@msn.com City State ZIP code Lyons OR 97358 Location and description of damaged or destroyed property Assessor's account number .R48826,R40826,' ' •: S r, i: _ . s: • _ ,- , t:_ • S-4768j-ep Location of property(if different from above) Section Township Range Tax lot number 10750 Wagner Road O7 Oqs .2E _ Description of personal property Lib All Date of damage Cause of damage Oregon Wildfires 9/8/2020 0 Fire(attach fire department report) IM Act of God(describe): Damage occurred to Z Land Il Building Z Personal property 0 Manufactured structure Describe damage Complete Devistation to Timber, Nursery trees, Greenhouses, Power poles, Main House, Guest house, storage buildings,bams, pump house and vehicles. • 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 submitte 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 dan 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 catcula and finalize the tax proration. Declaration I declare under the penalties for false swearing[ORS 305.990(4)j that I have examined this document and to the best of my knowledg it is true,correct,anal-complete. , Applicant's signature f 4 Date s 4- —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: (I-2.5110 Clerk:ar Date received: (( .2.1. 20 Clerk: IQ✓ Q(o Damaged property: This year Land and improvements: Real market value( MV)before RMV after Date rebuild complete: Months prorated: fire/act of God (5000 fire/act of God: g2-4 r V Assessed value(AV)befor Value Amount of adjustment/refund: fire/act of God: Q 2 3 d percent of loss: .111 Destroyed property: This year Personal property: Months prorated: RMV before RMV after fire/act of God: fire/act of God: Cj L 2�� oq AV before Value Amount of adjustmen refund• L. fire/act of God: percent of loss: Remarks: Date property visited: /6-249-2,0 ❑Damaged ❑ stroyed c 3 a L-f/ a1 x04,62, 11,, 150-310-083(Rev.12-15)