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Application for Proration of Property Taxes For county use only Due to Damage by Fire or Act of God Date Oregon Revised Statutes(ORS)308.425 instructions: •Applcation 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 htaiNng address chy State ZIP code G.or,r\ i. d 1. Location and description of damaged or destroyed property Assessor's amt number 1 FZ3 S `loZ\ / (poi-I V Location of property(if different horn above) Section Township Range Tax lot number 330\.1,"cs�'�F tk -S oZ ock 3 . ,Oo3o 0 Description of personal property � of damage S, CS�C�of % ,,..., mage ci � \ZK Elft(attach fire department report) 0 Act of God(describe): Damage udT_artd 0 Building 0 Personal property 0 Manufactured structure Q oesaiee 4\ mo� � �� oss � \"c- \�,��e� S �(...0- otic Act Application for proration of tax `C O�5� � L�Ffaert applying to have the above property examined for proration of property taxes per ORS 308.425.Application must be 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 wiN 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. App t ��1 0\�j \ZO Date —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: 2-z3-2I Clerk: /7f Date received: Clerk: Damaged property: This year Land and improvements: Dale rebuild corrrplete: Months �_ Real market value be RMV after i TO VALUE Assessed value�firelact of God: before_ � o of cod: Ili F f � UN1-" fve/act of God: D.�eyed pJ& CHANGE 1 Value ! ' 3f'1 I percent of loss: This year Personal property: tio RMV before RMV af Months prorated: fire/act of God: fire/actofGod: Amount of adjustment/refund: ^-- AV before Vaue { fire/act of God: percent of loss: ; Remarks: ' Date property visited: ❑wed ■,11 i.yed I 150.314083 flev.12-15) I b