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S ' circ. 4_6 Application for Proration of Property Taxes For county use only Due to Damage by Fire or Act of God Date eceived Oregon Revised Statutes(ORS)308.425 ( it - 5-- 7r>2c-: 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. Applis name Phone iPL)wt1d Cihieit.t/ek.lh.- 1 Z'5 i::. it., 3 ?9t -7740 Mail ng address • Email(optional) na 3'S'S Azw+ic E(�.@ �,¢i ,Comet Ci State ZIP code 4.1, -a, . __.._...---....---_-..__ - _.............._._. C_ ___........ CI 12$ - .._._.__._... Location and description of damaged or destroyed property Assessor's account number •R41716 / 541716 Location of property(if different from above) Section TownshipRange Tax lot number t 630 North Santiam Hwy 706 .07 3E &icia) Description of personal property • Gates, OR ias M0 'j GLsd..Lrlrr Of.- Date of dama a Cause of damage �� J q/Z � l:Fire(attach fire department report) Dict of God(describe):QZ 1►) LA2lC WEI-5 Damage oc rred to � Riand Eirtluilding 12-Personal property LS'Manufactured structure Describe damage a t r • ki .(coe(..�,2L(-5 i () So+a rti pLop sal 1 ` 1aCf.�carp1r'!r[`. t I�OuILLO.35 �2� 4 I ng j +� IN I ttitc .,44. ,Tu,�� a A-v c-ro� s, pfd-v is•-i, 4 ,,.,k5, b . . . • , c` � � Application for proration of tax _ ILMI 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 tr , orrect,an complete. �� • pylic i/s signature —, Dal 161,20/2c,"!�/,�f {J% —Applicant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: (2.-3 -'i.(J Clerk:/' Date received: 12- I-.2..0 Clerk: in)`f U tp Damaged property: This year Land and improvements: Q p MV after Date rebuild complete:,....__._.`— prorated: .__ ffiie/act eal market f God:value(RMV)before React of God: Q 9 1S oa Months �3�DSO Assessed value(A L%f e 'J Value Amount of adjustmenVrefund: fire/act of God: I. Y� percent of loss: V a 35K3 Destroyed property: This year Personal property: w w " RMV before RMV after ,vlonths prorated:�_ ________ fire/act of God: fire/act of God: q AV before Value Amount of adjusttment/ ""527'23 Lire/act of God: percent of loss: Remarks: _� Date property visited:JA-)0 'A0 ❑Damaged CDestroyed 05F,n 0.orj yid 150-310-083(Rev.12-15)