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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 David Braun representative of Chemeketans 503-999-1077 Mailing address Email(optional) 2225 Ladd Ave. NE aavldbraunf comcast.net City State ZIP code Salem OR 97301 Location and description of damaged or destroyed property Assessor's account number 542491 4- q-q Location of property of different from above) Section Township Range Tax lot number MAP: 107E00-00-02100 Al Description of personal property National Forest Road 2243 Cabin Date of damage Cause of damage 9/9/2020 0 Fire(attach fire department report) <]Act of God(describe): Lions Head Forest Fire Damage occurred to ❑Land 0 Building 0 Personal property 0 Manufactured structure Describe damage The structure was completely burned to the ground.The structure is located on leased Forest Service Land. Application for proration of tax l 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,clrrect,an m lete. X r l / F- :� 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: I/723-20 Clerk:/ Date received: Clerk: Damaged property: This year Land and improvements: Real market value(RMV) eto a RMV after Date rebuild complete: Months prorate fire/act of God: /�o 750 fire/act of God: 471 Assessed value(AV)before Value r1/� Amount of adjustment/refund: " ' fire/act of God: JZ/4//O percent of loss:_'t/ Destroyed property: This year Personal property: Months prorated G// RMV before RMV after fire/act of God: fire/act of God: _ AV before Value Amount of adiustmen fund. 264,68 iire/act ut Oud. percent Dt loss._ Remarks: Date property visited: 0 Damaged , estroyed MO 1ZS SOD 1b .T. 4j:7.-/14 I1-23,2oM) -/d — 150-310-083 (Rev.12-151 � 1