Form Lb-50 - Notice Of Property Tax And Certification Of Intent To Impose A Tax, Fee, Assessment, Or Charge On Property - 2004-2005

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Notice of Property Tax and Certification of Intent to Impose
FORM LB-50
a Tax, Fee, Assessment, or Charge on Property
2004–2005
To assessor of ______________________ County
Check here if this is
an amended form.
• Be sure to read instructions in the 2004–2005 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
Contact Person
Title
Daytime Telephone
Date
CERTIFICATION—You must check one box.
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 294.435.
PART I: TOTAL PROPERTY TAX LEVY
Subject to
General Government Limits
Rate –or– Dollar Amount
1. Rate/Amount levied (within permanent rate limit)
1
2. Local option operating tax
2
Excluded from
3. Local option capital project tax
3
Measure 5 Limits
4. Levy for “Gap Bonds”
4
Dollar Amount
of Bond Levy
5. Levy for pension and disability obligations
5
6a
6a. Levy for bonded indebtedness from bonds approved by voters prior to October 6, 2001
6b
6b. Levy for bonded indebtedness from bonds approved by voters after October 6, 2001
6c. Total levy for bonded indebtedness not subject to Measure 5 or Measure 50 (total of 6a + 6b)
6c
PART II: RATE LIMIT CERTIFICATION
7. Permanent rate limit in dollars and cents per $1,000
7
8. Date received voter approval for rate limit if new district
8
9
9. Estimated permanent rate limit for newly merged/consolidated district
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 year
Final 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.)
(see the back for worksheet for lines 6a, 6b, and 6c)
150-504-050 (Rev. 1-04) Web
File with your assessor no later than JULY 15, unless granted an extension in writing.

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