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Y Application for Proration of Property Taxesri�'�^i: : ;rig Due to Damage by Fire or Act of God Date received Oregon Revised Statutes(ORS)308.425 , 1 I Instructions: •Application for proration of property taxes may be made for the tax year of the property damage/destruction.If approved,thi xedu>�ethg a,,lm�ount of tax due or result in a tax refund.The tax year is from July 1 to June 30. V1I�V�1,cVl1N •Your application must be filed within 60 days of the damage or by June 30 of the tax year in which the damage occurredT"vtiflit'rte'�€GTaa. •File your application with the county tax collector of the county in which your damaged property is located. Applicant's name Phone 1•) Lfea `11405171 , Mailing address J� r Email(optional) 1 V•I'd 3 Cao Vc/t/ City.- \ Ctjel 1 St�je Z ZIP code3 (Y/► Location and description of damaged or destroyed property`s}{ lig Assessor's account number R41047 / 541047 Location of property(if different from above) Section 1_,6„, ,6`i Township C> 7 I Range / Tax loot;number , 22086 North Fork Rd SE --VD r 0 14 cs-) Description of personal p perty Lyons, OR 97358 Date of damage Cause of damage 1 CH 1- 3er .)-C) ❑Fire(attach fire department report) [.Act of God(describe): ?!� IJDamage occurred to 0 Land 0 Building l Personal property Manufactured structure Describe damage — �p -� 7_0' �� oor�oti Application for proration of tax '� G c,QP 0 I am applying to have the above property examined for proration of property taxes per ORS 308.425.Application mustP�{ed within 60 days of damage or June 30,whichever is later. 4 Q -) 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 complete. X /J(MA C Q /v - a'? an 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: ii-640 Clerk: 5 Date received: l,. 3- ZO Clerk: VII C( '' Damaged property: This year Land and improvements: Real market value(RMV)before RMV after Date rebuild complete: Months prorated: fire/act of God: ,-)eselaD fire/act of God: 13 I V 7O Assessed value(AV)before ..._ Value 0, ij0� Amount of adjustment/refund: --- fire/act of God: 15yU.1percent of loss: Destroyed property: This year Personal property: RMV before RMV after Months prorated: q fire/act of God: fire/act of God: AV before Value Amount of adjustment/*Serwl: '~201.4 7 fire/act of God: percent of loss: Remarks: Date property visited: f 2-3-2O 0 Damaged /Destroyed / F+ 150-310-083(Rev.12-15)