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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 name Phone George Beekman 541-760-7922 Mailing address Email(optional) 3825 NW Hayes Ave. georgebeekman@gmail.com City State ZIP code Corvallis OR 97330 Location and description of damaged or destroyed property Assessor's account number R42138 5 a i Location of property(if different from above) Section Township Range Tax lot number Devils Creek Lot 21, Forest Service Rd. 896, Detroit, OR 97342 21 9S 7E 097E21ceoo1000g Description of personal property House, shed, and contents Date of damage Cause of damage Sept. 8, 2020 I Fire(attach fire department report) ❑Act of God(describe): Damage occurred to ❑Land 0 Building EI Personal property ❑Manufactured structure Describe damage ce Apparently totally destroyed based on aerial photos W NO 0 co c' U w U.1 r-t p U Q ¢ Application for proration of tax CC o El 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 com lete. X Applicant's signu3t re " Date —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: /2•440 Clerk: ir Date received: Clerk: Damaged property: This year Land and improvements: Real market value(RM efor RMV after Date rebuild complete: Months prorated: fire/act of God: /o 75a fire/act of God: Or Assessed value(AV)befoxe Value //r� Amount of adjustment/refund: fire/act of God: /t>!y70 percent of loss: I/I/ Destroyed property: This year Personal property: RMV before RMV after Months prorated: / fire/act of God: fire/act of God: AV before Value Amount of adjustment/ fire/act of God: percent of loss: Remarks: Date property visited: ❑Damaged stroyed ,4)ef SSS /31 /PM/014 / v ///0/%�2 16 150-310-083(Rev.12-15)