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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 Lloyd Chapman /Susan Graves 503.362.9025 Mailing address Email(optional) 1240 Hillendale Dr. SE susanlloyd@peak.org City State ZIP code Salem OR 97302 Location and description of damaged or destroyed property Assessor's account number R42114 5 Y.2. l t y Location of property(if different from above) Section Township I Range !Tax lot number Devils Creek Summer Home Tracts, Lot 101 Description of personal property Dwelling and all household belongings Date of damage Cause of damage Sept 8, 2020 ❑D Fire(attach fire department report) ❑Act of God (describe): _ Damage occurred to ❑Land 0 Building I:Personal property ❑Manufactured structure Describe damage C Cabin and its contents are a total loss W o ?cc > N6' O vc`�n — Z 'I Application for proration of tax —[al o cc X I am applying to have the above property examined for proration of property taxes per ORS 308.425.Application musfbe 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 trueorrect, and complete. x 7 L• )(Litt- 1:, /o/e) /2-0 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: (2-4-2 i Clerk: /I Date received: Clerk: Damaged property: This year Land and improvements: Date rebuild complete:___.__.._._.._.._. Real market value(R V) efore RMV after p Months prorated: fire/act of God:-- fire/act of God:_..._ Assessed value(AV)befgre Value Amount of adjustment/refund: fire/act of God: 3 SN3O percent of loss:- /00 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 adjustr ien efund: 278.lb fire/act of God:_ percent of loss: Remarks: Date property visited: ❑Damaged *estroyed Our Forest Service cabin on Devils creek was destroyed by the Lionshead fire. 150-310-083(Rev.12-15) — --- — - a