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j 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 ebr) g 1 w, 9273 5a9- c9 a0 Mailing address Email(optional) 22A155 Je,i4e Rd- 'eonJrnscs ma � r• -ka,r,co^ City l.�o�S 0 R C)736- atg� ZIP Ode �' Location and description of damaged or destroyed property C� Assessor's account number c 3� (o I Lf 1 CPi LI 03 Location of property(if different from above) Section Township Range Tax lot number 224153 N. Sc,,•. kkel Nom) 19-btPt cPi .2.e 092E 1 g, c Description of personal property I''')e h2plq O R G)311 5'176 c ce5 Date of damage Cause of damage q-ir ,' 202C? $Fire(attach fire department report) \ct of God(describe): rorr Five- Damage Damage occurred to _and RBuilding .Personal property Manufactured structure Describe damag)e )(99/ ©4' IVIctila- -}urf d 1401"e-1 '30‘t60 3k pi g0,6 o-F 4hv her liv4ctApplication for proration of tax 0 0 am applying to have the above property examined for proration of property taxes per ORS 308.425.Application nt be s mittcc within 60 days of damage or June 30,whichever is later. _ N 0 u) Whether my property is damaged or destroyed will be determined by the County Assessor's office.If the assessor determines my pr rty i 1ty d U-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 th Ir uty tto calcu�e and finalize the tax proration. WC-) FcQ Lt o 2 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. '4)4 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: II-21-20 Clerk: Date received: /0:,2?/, 26) Clerk: ZOO O(.0 Damaged property: This year Land and improvements: Real market valu€A9MM before RMV after Date rebuild complete: Months prorated: fire/act of God: 7.20 fire/act of God: U Assessed value(A)0 before „ Value j Amount of adjustment/refund: `”- - fire/act of God: (0-1 !•( percent of loss: 0 Destroyed property n This year Personal property: RMV before RMV after Months prorated: fire/act of God: fire/act of God: AV before Value Amount of adjustment/efund 2(01 i 5 fire/act of God: percent of loss: Remarks: Date property visited: `0 -.-,'2- ElDamaged estroyed rt)al ha / 150-310-083(Rev.12-15)