Instructions For Form Lb-50 - Notice Of Property Tax And Certification Of Intent To Impose A Tax, Fee, Assessment Or Charge On Property Page 4
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4Form LB-50 Sample
2001–2002
Notice of Property Tax
FORM
LB-50
and Certification of Intent to Impose a
Tax, Fee, Assessment or Charge on Property
Sample
To assessor of ______________________ County
Check here if this is
an amended form.
• Be sure to read instructions in the 2001–2002 Notice of Property Tax Levy Forms and Instructions booklet.
City of Illustration
The __________________________ has the responsibility and authority to place the following property tax, fee, charge or assessment
District Name
Sample
on the tax roll of ______________________ County. The property tax, fee, charge or assessment is categorized as stated by this form.
County Name
123 Main Street
Illustration
OR
97000
Mailing Address of District
City
State
ZIP
A. Test
Mayor
(503) 378-0000
6-29-01
Contact Person
Title
Daytime Telephone
Date
Enter rate or
Subject to
PART I: TOTAL PROPERTY TAX LEVY
amount. Carry
General Government Limits
rate out four
Rate –or– Dollar Amount
decimal places.
1.7000
1. Permanent rate limit tax (per $1000)
1
5,000
Amounts and
2. Local option operating tax
2
rates entered in
Excluded from
.7510
3. Local option capital project tax
3
Measure 5 Limits
boxes 1–6
0
must be the
4. Levy for “Gap Bonds”
4
Dollar Amount
same as what
of Bond Levy
0
is in the
5. Levy for pension and disability obligations
5
resolution.
$
5,656
6. Levy for bonded indebtedness not subject to Measure 5 or Measure 50
6
Certification—Check one box.
X
Must be a
The tax rate or levy amounts certified in Part I are within the tax rate or levy amounts approved by the budget committee.
dollar amount.
The tax rate or levy amounts certified in Part I were changed by the governing body and republished as required in ORS 294.435.
PART II: RATE LIMIT CERTIFICATION
Must check
box indicating
1.7000
7. Permanent rate limit in dollars and cents per $1,000
7
the tax is within
N/A
the rate or
8. Date received voter approval for rate limit if new district
8
amount
N/A
9. Estimated permanent rate limit for newly merged/consolidated district
9
approved or
box indicating
PART III: SCHEDULE OF LOCAL OPTION TAXES — Enter all local option taxes on this schedule. If there are more than three taxes,
budget was
attach a sheet showing the information for each.
republished.
Purpose
Date voters approved
First year
Final year
Tax amount per year –or–
(operating, capital project, or mixed)
local option ballot measure
levied
to be levied
rate authorized by voters
Operating
Nov. 2, 1999
2000
2002
$
5,000
Must be
completed if
Capital project
May 18, 1999
1999
2006
$
0.7510
you have local
option tax
authority.
PART IV: SPECIAL ASSESSMENTS, FEES AND CHARGES
Subject to General
Excluded from
Description
Government Limitation
Measure 5 Limitation
$ 10,000
Delinquent Sewer Charges
1
2
If fees, charges or assessments will be imposed on specific property within your district you must attach a complete listing of prop-
erties, by assessor’s account number, to which fees, charges or assessments will be imposed. Show the fees, charges or assess-
ments uniformly imposed on the properties. If these amounts are not uniform, show the amount imposed on each property.
Complete this
224.400
The authority for putting these assessments on the roll is ORS _____________.
(Must be completed if you have an entry in Part IV.)
line only if
there is an
150-504-050 (Rev. 12-00)
amount in
File with your assessor no later than JULY 15, unless granted an extension in writing.
Part IV.
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