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Application for Proration of Property Taxes lfgdixy Piy Due to Damage by Fire or Act of God Date received Oregon Revised Statutes(ORS)308.425 NOV 0 6 2020 Instructions: •Application for proration of property taxes may be made for the tax year of the property damage/destruction.If approved,th clieetiNg i(ount of tax due or result in a tax refund.The tax year is from July 1 to June 30. TAX COLLECTOR •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. Applic nt's name CrvaA:rs,,....) nw,,•�' Phone Mailing address ge® ��1S- S Email(optional) t 7ZJ{ O C`(Y'IIn0 State ZI• ode_ JZAt Location and description of damaged or destroyed property Assessor's account number R343112 / 343112 t-1 AC O q A E O/(o Location of property(if different from above) Section Township Range Tax lot number 22300 Nv.LI r f.,.lc-R-d OC — ---- 1—V%)ti i --- --- ---- - Descriptionn of personal pjbperty Lyons, OR 97358 Date of damage Cause of damage 9 g . 0 0 Fire(attach fire department report) gAct of God(describe): p LIZ-4- Damage occurred to 0 Land ❑Building ,Personal property ArManufactured structure Describe damage10 .1;W:Ary.t...-- c G0 .e,U44A1\ 1 G.- ,-. Z° oo Application for proration of tax 001-:<%,.*Ct v0;0 I am applying to have the above property examined for proration of property taxes per ORS 308.425.Application m u ittO d within 60 days of damage or June 30,whichever is later. D 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, correct,and com fete. )1 � X /v (XPA 10 D I lo 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: No Zo Clerk: ar Date received: t I- 30- 20 Clerk: LAW 1)b Damaged property: This year Land and improvements: --....--- `� Real market value(R �effoore RMV after r+�p Date rebuild complete: Moo�n ``!?' fire/act of God: p( `v fire/act of God: o� /DO ^l1^`' 16� Assessed value(A of Value i�i d nd fire/act of God: 4 ' percent of loss: ID Destroyed prope � „,"1 This year Personal property: P�JJ,�V`\+`�� + RMV before RMV after CNG Months prorated: fire/act of God: fire/act of God: NOV _ AV before Value Amount of adjustment/refund: fire/act of God: percent of loss: Remarks: Date property visited: 0 Damaged 0 Destroyed d 150-310-083(Rev.12-15)