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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. O�' Applicant's s name //,� -TEFFIZE Y LALF�E vs V .. 836 '4 Mailing address !Email(optional') 07436. N FENWI LK AVE I FFA1_ 6ge-&MAI L. ColA City I State ZIP code IbRTLAN D 1 R 1472,17_ Location and description of damaged or destroyed property Assessors account number 5�+ 2 16 7 Location of properly(if different from above) Section Township 1 Range 1 Tax lot number I2EVI Ly tREEK LOT 0g7E2.00AboiCtx Description of personal property Date of damage Cause of damage q11/242j )4 Fire(attach fire department report) ❑Act of God(describe): Damage occurred to 0 Land gBuilding .Personal property ❑Manufactured structure Describe damage ( I �t I -1-04&1 loss 0c 6k, Id:v1 6kn0k pro16/7r Wi h v tra .� +L Lion,SkeAsk �rL, uj e Z cr J > N 0 0 co -LU ' CJ tq Application for proration of tax -- O Al am applying to have the above property examined for proration of property taxes per ORS 308.425.Application must be l;MmittCd Q 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 lO-�� 2020 Appli 's ture Date —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: r y-4-2,p Clerk: /r Date received: Clerk: Damaged property: This year Land and improvements: Real market value(RMV)before RMV after Date rebuild complete: Months prorated: "' fire/act of God: f7 fire/act of God: Assessed value(AV)beemi�re ��/� Value //��//�� Amount of adjustment/refund: fire/act of God:_______" ! percent of loss: _KC_ Destroyed property: This year Personal property: =t RMV before RMV after Months prorated: —_ ______ fire/act of God:—__ fire/act of God: 32 7�O Z AV before Value Ur� Amount of adjustmenc{uRd�: fire/act of God: percent of loss: • Remarks: Date property visited: ❑Damaged ( estroyed Plitt OW Pecittato-t 41popozo _Coo_ a0-310-083:Rev.12-t51