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FOR ASSESSOR'S uSNQ'EIVED <br /> Form OR-C-RHSA-2 Date Received <br /> Page 1 of 1,150-303-009 Oregon Department of Revenue Approved Denied MAR 1 0 2025 <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? Yes I No <br /> As <br /> provided by Chapter 94,Oregon Laws 2024(SB 1545) <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 ! I IL r v County Assessor for the tax year beginning July 1,20 2 <br /> ftr� 6' <br /> Part A—Description of homestead(please print or type) <br /> Fill-in the-bows below to'show-the-property you-want to have-specially assessed under the-rebuilt-homestead-program:, <br /> Property tax account number Map,tax lot,or parcel number Homestead situs(physical address) <br /> 6 D CtC 0612E 11 d MOO 7-3a( -f 5u (NI lit er1Aavp\ <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 for the entirety of the property tax year." <br /> I(owner) u V\ 1p r� 0(AI'\€ (please print)indicate by my signature I will continue <br /> to occupy the reCk ilt homestead as my principal welling 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 <br /> Applicant signature Date <br /> here� `^ Vi'otwacX <br /> �_1,014/ <br />