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1 512025 16:19 <br /> Nancy Fink 386 266 9047 P 1 <br /> • <br /> • <br /> pro FAx <br /> \o-1 <br /> ,;, m FOR�E5SOR'$116E ONLY <br /> iii5 'r$kfiCgAr," <br /> r •t Form OR-C-RHSA-2 <br /> Page1 a►t.7S0.3P3 009,tt Oregon Department of Revenue Etppravzx! �• 1 Denied <br /> {Rely,07-26-24) IJatA: BY_ <br /> V3;6 Attestation for Continued Qualification of Rebuilt <br /> . Homestead Special Assessment outran*sr�,u,iry a �a� r-1 l_� Yes ❑ No <br /> provided by Chapter td4,Oregon t awe 2024(SB 1546) ammanim <br /> lc <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, 150408-007-1. <br /> t Flied wish the,,, County Assessor for the tax year beginning July 1,20,,,41 . <br /> x <br /> Part A—Description of homestead(please pint or typo) <br /> . Fill In the boxes below to show the property you want to have specially assessed under the rebuilt homestead program. <br /> Property tax account number.559 Map,tax lot,or parcel number Homestead taus(physical address) <br /> -i1[ L g . 3 Rex.,Ircx d kit' <br /> ��° �� � Go 6- s flak g735/(4' <br /> ) <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 la 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 owners principal dwelling for the entirety of the property.:tax year." <br /> 4k <br /> -i(ownereAlifteS `1-Ala/Icy%. F.,-)A-. (please print)indicate by my signature I will continue <br /> to occupy the rebuilt homestead as rr(y principal dwelling 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 examined this document,and to the best of my knowledge,it is true,correct,and complete. <br /> sign Applicant signature .W <br /> [here, Date <br /> „f� t <br />