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e,Mc D 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 ( (D 2.6z6) 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 Terry R. Behrens 503-476-7200 Mailing address Email(optional) 10004 Wagner Rd trbehrens1@gmail.com City State ZIP code Lyons, OR 97358 OR 97358 Location and description of damaged or destroyed property Assessor's account number ,540789,6498-78. 12-4 g 1 Q Location of property(if different from above) Section Township Range Tax to umber Description of personal property Household contents,cars,equipment and tools Date of damage Cause of damage 9/8/2020 CI Fire(attach fire department report) ®Act of God(describe):Beachie Cr fire Damage occurred to EI Land 0 Building ID Personal property ❑Manufactured structure Describe damage House, Garage, Barn,fencing and live stock feeders are a total loss, extensive timber damaged throughout all tax lots 6° Application for proration of tax 0 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. X ql*„) 10/9/2020 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: 1-1-11 Clerk: /be Date received: Clerk: Damaged property: This year Land and improvements: p TMENT l .avl�t Real mct o f value(RMV)3before RMV after /�". Date rebuild complete: Mon fire/act of God: 9GY� fire/act of God: JJ • pp�UST�* TM�� Assessed value(AV)before Value Amu/OgleuT fire/act of God: / Q percent of loss: Destroyed propertpo Cr' This year Personal property: Months prorated: RMV before RMV after fire/act of God: fire/act of God: • AV before Value Amount of adjustment/refund: 'r fire/act of God: percent of loss: Remarks: Date property visited: 0 Damaged 0 Destroyed dOCOM) 8y i),{,2. '' '1,i #0.070 /o"24`24)z.o 150-310-083(Rev.12-15)