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15 20,05:50p JohnsonRV 5034820155 p.1 Application for Proration of Property faxes For county use only Due to Damage by Fire or Act of God Da'e,ecei`._-i Oregon Revised Statutes (ORS)308.425 I C) - l 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_ 44' ( (144 C t- , (2 Ale_ J' r`a? - 72e- „S,3 u.7 Mailing addre / , j Emai optional) : d r (3 0 n 2 Z tit-0 ,.? 44 ds9NF f9Aidem,ca.v city S ZIP lgd Y Z Location and description of damaged or destroyed property Assessor's account number . R58595 1 558595 Location of property(if different from above) - Section Township Range a... at number 35405 Ruth St SE 32BD 08S 4E 5.--J0 Description of rsonal property / . Lyons, OR 97358 tvrivI'S'Ai'��-r' -N"/ ti c,✓J - -1- V-"' ' ° ' -1 S Date of d mage 1_4" Cause of damage x . / . I . �' 7 Zci Z 0' 0 Fire(attach fire department report) kAct of God(describe): Int/i `I R A I `l W I A" Dam ge.ocxurred to kLand KBuilding Jpersonal prcperty 0 Manufactured structure . Describe damage ✓ / r ( Q // e_r h0 4i z 4 ij b✓n / ,ii • Q.s / t;2e 4...,,I f r.. Tfsr oz-s6;oye • , 41/ Rr - #9-/ Aofz02 1 4/ro r e_0, y __ -_ ---- Application for proration of tai 711 arrtiplilying 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 proratior. Declaration I declare under the .- es for false swearin [0 S 305.990(4)]that I have examined this document and to the best of my ,*nowledge it is true,co - , . d compl . f • `4 X ' l 4A 5/2_0' 2- O 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: 2'5'11 Clerk: NI Date received: . Clerk: Damaged property: This year Land and improvements: Real market value(RrMIVi before RMV after q Date rebuild complete: Months proret Y firelact of God: /93/880 fire/act of God: 11J/3� I meIVe t TO Vii- Assessed value(AV)before Value Wool athuslm ekAMMO' fire/act of God: 914%/TO percent of loss: Destroyed property MA lCH G This year Personal property: V RMV before RMV after Months prorated: -- __ fire/act of God: fire/act of God: AV before Value Amount of adjustment/refund: fire/act of God: percent of loss: - - Remarks: �2 A Date property visited: ❑Damagedestroyed� (LO( `c6b V1 Dioar--- A-_ tim 11117 21,U' (. 0 loo 910-063 iFiev.12-t5)