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Application for Proration of Property Taxes F rd�cijr Due to Damage by Fire or Act of God Date received Oregon Revised Statutes(ORS)308.425 NOV 2 4 2020 Instructions: •Application for proration of property taxes may be made for the tax year of the property damage/destruction.If approved,thilvARICOPI,UCIDUNINount 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. Applicants name Phone Marlene Burroughs 503-910-2108 Mailing address Email(optional) 5545 Joseph St. S City State ZIP code Salem OR 97301 Location and description of damaged or destroyed property Assessor's account number 542019 49-c,l Location of property(if different from above) Section Township Range Tax lot number 38009 North Santiam Hwy SE 2 40 0610U(Q00 Description of personal property Gates, OR 97346 Date of damage Cause of damage CVO focfG;tie n 09/15/2020 1 Fire(attach fire departmpo Act of God describe): Damage occurred to ,Land 0 Building 0 Personal property 14 Manufactured structure Describe damage Fire damage to address at above for 38009 North Sanitam Hwy SE 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 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, - d complete. p� 11/12/2020 Ap can signature Date —App ant will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: 2-21-2.1 Clerk: /ir Date received: y,�_9.10 Clerk: (00 0 (Q Damaged property: This year Land and improvements: Date rebuild complete: Months rorat Real market value(RMV)before RMV after ',, P p atc , fire/act of God: �l`1 O 1{Q fire/act of God: (�5 ot-46 vt►LV` Assessed value(AV)before Value tt a� �d�u3tm r:, \�,4 Oft--, fire/act of God: 33 c't�-k U percent of loss: D Destroyed proU 1 tv„' C tO tW' This year Personal property: CNpNG Monthsrorated: RMV before RMV after p 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:O....01?-0V 0 Damaged pnestroyed 150-310-083(Rev.12-15)