Form Lb-50 - Notice Of Property Tax And Certification Of Intent To Impose A Tax, Fee, Assessment, Or Charge On Property - 2016-2017

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FORM LB-50
Notice of Property Tax and Certification of Intent to Impose
2016–2017
a Tax, Fee, Assessment, or Charge on Property
To assessor of ______________________ County
Check here if this is
an amended form.
• Be sure to read instructions in the current Notice of Property Tax Levy Forms and Instructions booklet.
The __________________________ has the responsibility and authority to place the following property tax, fee, charge, or assessment
District name
on the tax roll of ______________________ County. The property tax, fee, charge, or assessment is categorized as stated by this form.
County name
Mailing address of district
City
State
ZIP code
Date submitted
Contact person
Title
Daytime telephone number
Contact person e-mail address
CERTIFICATION—You must check one box if you are subject to Local Budget Law.
The tax rate or levy amounts certified in Part I are within the tax rate or levy amounts approved by the budget committee.
The tax rate or levy amounts certified in Part I were changed by the governing body and republished as required in ORS 294.456.
PART I: TAXES TO BE IMPOSED
Subject to
General Government Limits
Rate —or— Dollar Amount
1. Rate per $1,000 or total dollar amount levied (within permanent rate limit) ... 1
2. Local option operating tax .............................................................................2
Excluded from
Measure 5 Limits
3. Local option capital project tax ......................................................................3
Dollar Amount
of Bond Levy
4. City of Portland Levy for pension and disability obligations ..........................4
5a. Levy for bonded indebtedness from bonds approved by voters prior to October 6, 2001 ....................5a
5b. Levy for bonded indebtedness from bonds approved by voters after October 6, 2001 ....................... 5b
5c. Total levy for bonded indebtedness not subject to Measure 5 or Measure 50 (total of 5a + 5b) ............5c
PART II: RATE LIMIT CERTIFICATION
6. Permanent rate limit in dollars and cents per $1,000 ................................................................................6
7. Election date when your new district received voter approval for your permanent rate limit ...................7
8. Estimated permanent rate limit for newly merged/consolidated district ...............................................8
PART III: SCHEDULE OF LOCAL OPTION TAXES— Enter all local option taxes on this schedule. If there are more than two taxes,
attach a sheet showing the information for each.
Purpose
Date voters approved
First tax year
Final tax year
Tax amount —or— rate
(operating, capital project, or mixed)
local option ballot measure
levied
to be levied
authorized per year by voters
PART IV: SPECIAL ASSESSMENTS, FEES, AND CHARGES
Subject to General
Excluded from
Description
Government Limitation
Measure 5 Limitation
1
2
If fees, charges, or assessments will be imposed on specific property within your district, you must attach a complete listing of
properties, by assessor’s account number, to which fees, charges, or assessments will be imposed. Show the fees, charges, or
assessments uniformly imposed on the properties. If these amounts are not uniform, show the amount imposed on each property.
The authority for putting these assessments on the roll is ORS __________________.
(Must be completed if you have an entry in Part IV.)
150-504-073-7 (Rev. 11-15)
Form LB-50 (continued on next page)
(see the back for worksheet for lines 5a, 5b, and 5c)
File with your assessor no later than JULY 15, unless granted an extension in writing.

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