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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 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 h o te-x tt P i eA.s e C14-4.r(es R. Be-ft vie-1-1- Sp-3- gl 7-.2.2.l t' Mailing address Email(optional) ?. D. 6 N 7 GP74 bell-Pa.h. l,4.K&9n.a:e.- c m City State ZIP code 5a1eieh. 0k 97303 Location and description of damaged or destroyed property Assessor's account number 531 -7 G 4. 9-fir c Location of property(if different from above) Section Township Range Tax lot number 3 3 6 2 2 Real ram) /4-we.., Description of personal property &C/tes, v 2 9 73st 16 -- t om... Date of damage Cause of damage c , 9- 7 -.2 D ao Wire(attach fire department report) 0 Act of God (describe): Damage occurred to [81 Land IgBuilding (Personal property 0 Manufactured structure Describe damage Q✓n-K "i - . � blA,u,ra4-4-4..+ ..a.4.,_�..:..j �. 1?.t�,Q .-tet- d-6.e. ►.-, ci,2 w ��,t. Application for proration of tax 0 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 propert 49y 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 thei 4,I,i' o calc late and finalize the tax proration. ,L� A414J Declaration $' \0�4t0 ` I declare under the penalties for false swearing [ORS 305.990(4)]that I have examined this document and to the best of m_x i�vytedge it is true a•/-ct, and complete. ��`` 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: 2-47-2/ Clerk: /sr Date received: Clerk: Damaged property: This year Land and improvements: Date rebuild complete: Months pro 11Y Real market value(RM before RMV after ,u ►ror`��4E ,to V�� .outo fire/act of God: 2.,?; �� fire/act of God: 2 7�/3cj a AD""AL�w`iWs qyt Assessede/act God: (AV)before r 7D Valuec iigte Destroyed grope 1�►` percent of loss: 0 CH 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: Remarks: Date property visited: 0 Damaged %Destroyed PcgEty L3 /� t.4---/ Zf, . 12///2.624 150-310-083(Rev.12-15)