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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 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 Ledn 1;,1151-/ 6"03 5Og- S9‘e3 Mailing address Email(optional) 272.41c6. Je n n:Q Rd 2C�/ leo-) klinsc a owl-42coif-)rr coif-) City L. on5.' O R "1 736 0 Statg� ZIP `7 7 37 CJ Location and description of damaged or destroyed property Assessor's account number c41 1 117 T2-4 [t l-i Cx3 c ) Location of property(if different fromo"above) Section Township Range Tax lot number S 724153 N. c.,4 N,v) 1015A Ci ' 092E I$,BA0,CCt Description of personal property Me►'diAcl O R G-1311 S,?S oct 5 Date of damage Cause of damage y Cl— 1 ^ 2020 *ire(attach fire department report) Oct of God(describe): core-'r �ltrt Damage occurred to lirLand 4Building .Personal property i ,.Manufactured structure Describe damage nNK.1 ore d Horne) 3O 60 silo i Q0� o-/ 4I' ' fj4ciI 10,1O Application for proration of taxCio I am applying to have the above property examined for proration of property taxes per ORS 308.425.Application ALI be mit within 60 days of damage or June 30,whichever is later. _ ic' V Whether my property is damaged or destroyed will be determined by the County Assessor's office.If the assessor determines my pickkrty illy d -w 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 thelutyW__c,alcutial and finalize the tax proration. (U tJ if Q cc o •S 5 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. P X - _ 0(9G4- 14 2.020 Appli.:- 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: I I-2-5-20 Clerk:ft Date received:10;:,9)-,20 Clerk: a V p(0 Damaged property: This year Land and improvements: ------- .----^ Real market value(RMV)before RMV after t i i �� Date rebuild complete: Months prorated: fire/act of God: 9 3 ii fire/act of God: 4- --—, Assessed value(A b fore Value Amount of adjustment/refund: fire/act of God: percent of loss: 0 •,Z 35} Destroyed property: no This year Personal property: RMV before RMV after Months prorated: 7 fire/act of God: fire/act of God: � AV before Value Amount of adjustment efund' J 15.142 fire/act of God: percent of loss: Remarks: • //� ``��" Date property visited: `Q '�3-�f)0 Damaged �estmyed C .'Y4� / fit d 150-310-083(Rev.12-15)