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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 pie t n n ; 5 A- San;r e_. . . ,i3d'o IA/nlSo3--.3,3- 63b< Mailing address �?,N +-tb rr) 1?0b ` c Email(optional) 1 /3 ' �hr, „ / `j J 1-, d )46.54te Z.kaeo ), h,c✓/ City ,Se---1 z.'-)r ) 0 P. 17 3 0�3 0 1 9-3 Location and description of damaged or destroyed property Assessor's account number R40907 / 540907 Location of property(if different from above) Section Township Range Tax lot number 25497 Taylor Park Rd SE /DOC Qq ab' 0/600 Description of personal property Lyons, OR 97358 t c t,,,0 Date of damage Cause of damage ` 'Pre- p}, S,�4 />t ac,zp J Fire(attach fire department report) 'fAct of God(describe): "v; r'4 Damage occurred to Land 0 Building ®Personal property '❑Manufactured structure Describe damage /� 1 . ) 7-r�V� -f-� / r 4; I d - . )/ 772.p cart, It t ,- � ��,^o P-1* . fie-e_-its- S' 5. 1-e.- �! J --') ; 3424-` 'D"--i: yiYAZ { ell `�" s`Lro r� cl Application for proration of tax-131 I am applying to have the above property examined for proration of property taxes per ORS 308.425.Application must beTitted 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 . • rty is o aged,I must notify the tax collector of the date that the damage is repaired.Such notice will serve to inform the tax collepto �n -ir duty®� late and finalize the tax proration. \0 e5 Declaration CPQ'?G-' 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 �� ,o _ oz7i-a 6 Applicant's s' nature Date —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: 2121 Clerk:// Date received: /)-1 7-2() Clerk: WV 6 6 Damaged property: This year Land and improvements: �`Y Real market value RMV)before RMV after /i/10610 �/ /J ) Date rebuild complete: `� IC nths.grQr q t I j fire/act of God: 18(o 8/0 fire/act of God: / / v A1C rit u vow”' Assessed value(AV)before Value O MATbf Ldf fire/act of God: 55 7(6 percent of loss: Destroyed property: No C 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: Date property visited:J/_214 20 ❑Damaged L estroyed Cu Al ce, G /7 150-310-083(Rev.12-15)