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Application for Proration of Property Taxes For county use only Due to Damage by Fire or Act of God Date eceived 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 �'awLes F, c u;rt`ng5-03 8i.Ff - 92-17 Mailing address Email(optional) 3ZO5 1-+►llsi de Lane. G. jiviletuirin5 @ COMC-45t.nat. City State ZIP code *al,evA OR. 91302. Location and description of damaged or destroyed property Assessor's account number _ R.4014-1 t ii-cD1 Location of property(if different from above) Section Township Range Tax lot number 35 d7 5 Ruth .5i': se 3Z BL- 05 5 4-E 1 2-7O0 , Description of personal property 5 Lyan tZ 9'7358 "Oh Pt JE hollrte.... + outbui(dl'lincj (2.' Date of damage Cause of damage pt 5, ZO ZO ❑Fire(attach fire department report) Igj4ct of God(describe): 6."‘e Cr'�k �lr'L Damage occurred to gLand ,Building [gPersonal property 0 Manufactured structure Describe damage -r e eeckc,Lti , Crretax. ‘`re burn.ed mu- suw►w>er r 14004 2. , two out bJAI' kircr, ct1I ee.c-5c)euk 1 p-z'pe-c-#/ (ron4ent5 of Towne, + outbu a ldirs' And apex YZac.re. of VW% or Ott 5 (o t. Application for proration of tax I am applying to have the above property examined for proration of property taxes per ORS 308.425.Application must be su edrr 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 i ly dard cC 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 alcuIR M 0 and finalize the tax proration. 1. o N 44 Z CD 0 CL 131—w0Q Declaration cn < CC 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 tru correct,13om te. ifs ZoZO X r Appli ant's ignature Date —App want will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: Clerk: Date received: Clerk: Damaged property: This year Land and improvements: Real market value(RMV)before RMV after Date rebuild complete: Months prorated: fire/act of God: fire/act of God: Assessed value(AV)before Value Amount of adjustment/refund: fire/act of God: percent of loss: . Destroyed property: . This year Personal property: Monthsprorated: 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 0 Destroyed 150-310-083(Rev.12-15)