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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 nam Phone Maili address V oaC 1� r6�r 501-101- IS Email(optional) P o fib' (41i53\ cc9 , Lco -a, City StateZIP code O� qi 2.1-1- __ Location and description of damaged or destroyed property Assessor'ss•account number �' Lirof 4) "12-1g `f 21 5. PetrceA Location of property(if different from above) Section TownshipRange Tax lot number Cre;, �r,.sL Nom'l wrest C to , -2-.1 Ct. S 1 E. 10 o F3 n Description of personal property 1?)`e l'14•141H4, fIZA11.d, 4 20 Date of damage q+ Ca dm aage h e.tr%i R r t P • i,ea.cini e �.--9-A-- t LI 6\"•S �V b� • t I )2.0 l Fire(attach fire department report) El Act of God(describe): Damye occurred td Land L'3 Building 0 Personal property ❑Manufactured structure Describe damage C.Ovv l •t S� Olt 'Pl 1 JRECEIVED 4 '"�t1nas 1 0•S$CSS1hCni .4- nnn11 • -+/V -Lev- cv 1-e- ,/v i, J•Alliati OCT 0 9 2020 Application for proration of tax MARION G• . 8 I am applying to have the above propertyo'ESSOR examined for proration of property taxes per ORS 308.425.Applicata 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 iti true,correct,and complete. < �qc PPIi is sign L 1 C` ;J 1 2-0 Date —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: (Z-1.l-20 Clerk: Date received: Clerk: Damaged property: This year Land and improvements: Date rebuild complete: ~r Months prorated: Real market value(RM before RMV after flre/act of God: 74;30 fire/act of God: Assessed value(AV)bef��'ee�� „sv Value / Amount of adjustment/refund: ----- fire/act of God: i•V O,�v percent of loss:_lw ' Destroyed property: r2 This year Personal property: Months prorated: RMV before RMV after fire/act of God: fire/act of God: ¢ AV before Value �v Arnount of adjustmsn -fund: 2'Z 3'Z 5' fire/act of God: percent of loss: Remarks: Date property visited: ❑Damaged")estroyed P12.0 CeSS1:.` gi 9et- Lr-- PeUYL,t U1/0/2420 a':i 150-310-083(Rev.12-15)