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RFCFIVED <br /> Form OR-C-RHSA-2 FOR ASSESSOR'S USE ONLY <br /> Date ReceivgcL 2025 <br /> Page 1 of 1,150-303-009 Oregon Department of Revenue Approved � Denied JA� 1 11 <br /> (Rev.07-26-24) <br /> Date: By: MARION COUNTY <br /> Attestation for Continued Qualification of Rebuilt ASSESSOR <br /> Homestead Special Assessment Currently Specially Assessed? <br /> As provided by Chapter 94, Oregon Laws 2024(SB 1545) Yes No <br /> Comments <br /> Instructions: <br /> •Attestation forms must be filed with the county assessor. <br /> •Contact your county assessor with questions on how or when to file the attestation. <br /> •Additional information about this special assessment program can be found on Form OR-C-RHSA Instructions, 150-303-007-1. <br /> Filed with the /27(2/e/0/1/ County Assessor for the tax year beginning July 1,20 2 9 <br /> Part A—Description of homestead(please print orype) 457//�p/e__S' f9_6,/ /� /_ / —�/Q,� <br /> Fill in the boxes below to show the property you want to have specially assessed under the rebuilomestead prograI <br /> Property tax account number Map,tax lot,or parcel number Homestead situs(physical address) <br /> 5-5-6 0;2 D c7.2 El: 6 I, „3 3 9.7- <s_; <br /> 00 -9o0 <-yoIv / <br /> Part B—Written attestation <br /> SB 1545 Section 1 (9)states"Eligible property shall be assessed and taxed as other property similarly situated is assessed and taxed <br /> beginning with the property tax year that immediately succeeds the earliest of: <br /> (a) The date on which the rebuilt homestead is no longer occupied by the owner as a homestead, except when the owner is <br /> required to be absent by reason of health or active military service; <br /> (b) The date on which the rebuilt homestead is rented to another person for any duration;or <br /> (c) The date on which the rebuilt homestead is transferred to new ownership." <br /> SB 1545 Section 1 (7)(b)states"For each subsequent property tax year for which the specially assessed value is claimed,the owner <br /> of the rebuilt homestead must file an attestation, under penalties for false swearing,that the owner will continue to occupy the rebuilt <br /> homestead as the owner's principal dwelling forfon the entirety of the property tax year." <br /> I(owner) KA/E55 5J C. /�C/Z. (please print)indicate by my signature I will continue <br /> to occupy the rebuilt homestead as my principal dwellin for the entirety of the property tax year.As owner of the above-described <br /> property, I acknowledge I understand the circumstances that may disqualify the property from special assessment and that I must <br /> file an attestation annually to continue the special assessment in the future:I declare under the penalties for false swearing[ORS <br /> 305.990(4)]that I have exa ed this document,and to the best of my knowledge, it is true,correct,and complete. <br /> Sign Applicant sig u <br /> here� <br /> X ,C� Date <br /> �C� ,,23, 25,-- <br />