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RECEIVED Application for Proration of Property Taxes Fgpnie die MC] Due to Damage by Fire or Act of God Date rec Oregon Revised Statutes(ORS)308.425 MARION COUNTY Instructions: TAX COLLECTOR •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 (7w1L •a Gerc-f c(:nE aet- k's 5b3 - t5i•A033 Mailing address Email(optional) Pe 6rx 4 013 ei0-rtyet-h liens 9VOIrco,64evi City State ZIP code Ly & s . q.--13 Ss Location and description of damaged or destroyed property Assessor's account number R41044 / 541044 Location of property(if different from above) Section Township Range Tax lot number 23305 Salmonberry Ln SE / 761) © 02C DOVOO Description of personal property Lyons, OR 97358 Date of damage Cause of damage q-5-bio BilfFire(attach fire department report) ❑Act of God(describe): Damage occurred to "` 0 Land [g Building 'Personal property 0 Manufactured structure `YYY O Describe damage � n. A 51611 fr ra t4 t b Hier, � �. #'Cl 1 J• G0 O co io c \rPP Application for proration of tax &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 inume 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, complete. x 4 Applicant's signature e /0 ^ ,27^Ao Date —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: 11-.2-i O Clerk: 171 Date received: w2 /-.70 Clerk: a()j/a{p Damaged property: This year Land and improvements: Date rebuild complete: Months r r ^�� Real market value(RM before RMV after -`� 'TO at O'"~ fire/act of God: 31\5'-t 0 fire/act of God: 3/0 9 tC `1,, 14 uNt Assessed value(AV)pe ore Value ADJIw C1�G , ' Personal of God: I y�Ott) percent of loss: �8�� V Vt This year �Personal property: Months prorated: --~ RMV before RMV after fire/act of God: fire/act of God: AV before Value Amount of adjustment/refund: fire/act of God: percent of loss: Rem s: Date property visited: /,9-JO-,2 0 0 Damaged 915estroyed 0,-)F n'1 (IA i'tr-rr o 150-310-083(Rev.12-15)