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11, 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 Jurie 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 tater. •File your application with the county tax collector of the county in which your damaged property is located. " name Phone II S rG�. Let brve r' 5D3'58D_ it, Maiaddress ..,.V.o. An, $rig E�4(.0ortial) ‘-:r1C5ert51Qrnsi II. . ► •7 : State ZIP...,: CP Location and description of damaged + • •_ CL Assessor's account number or destroyed property Location ofP►operty�different from above) � I� " �� Section 1 l i t C eMrd P4Ait C% es, property V R 173 6 Q:nies�ittle Township I `ian9e ir Tax lotmmi4Description of personal yCIO �C FA exiiiii% i �d�� 1Cause of damage0 Fire(attach fire department report)�Act of God(describe): s r i lit e: :•:occurred to '' LandiTtr Building 0 Personal property ,Manufactured structure ft re5 a i n.) i t ' Qu 1 I ai noise9, gimes fi XApplication for proration of tax t am applying to have the above property examined for proration of property taxes per ORS 308.425.Application mu ub fitted within 60 days of damage or June 30,whichever is later. `` Whether my property is damaged or destroyed will be determined by the County Assessor's office.if the assessor det ta/� ',ly d m- aged,I must notify the tax collector of the date that the damage is repaired.Such notice will serve to inform the tax col of their• + and finalize the tax proration. •calcl�ate 1' G. Declaration x01*JPO • I declare under the penalties for false swearing[ORS 305.990(4)]that I have examined this document and to the best of my knowledge it is true,correct,and complete. 611.111,l signature /V/Q 4co Date —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: 11-23-2 0 Clerk far Date received: Damaged property: Cleric This year Land and Improvements: Date rebuildcomplete: Months prorated: �– Real market value(RMVLgefore RMV after . fire/act of God: ' ,3 30 fire/act of God: Amount of adjustment/refund:f Assessed value A tp:/ i 3 Pv Asserflreact of God: (AV) ValueV`, Destroyed property: / percent of loss: /Vv , This year Personal property Months prorated: 9 RMV before RMV after fire/act of God fire/act of God: Amount of ad ustment, — 2 0$ "30 AV fire/act oe � of God: percent of loss: Remarks: Datero P Party visited: 0 Damaged 0 Destroyed 150-310-083(Rev.12-15) pc i