Form 150-303-065 - County Assessor Stipulation
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For department use only
STATE OF OREGON
Date received
DEPARTMENT OF REVENUE
In the matter of the petition of
_____________________________________________
STIPULATION
_____________________________________________
_____________________________________________
Petition No. _______________________
_____________________________________________
The petitioner has requested that the Oregon Department of Revenue reduce the value on the tax roll of certain
property identified in the _____________ County Assessor's records by the account numbers listed in the attachment
to this order.
The parties agree to the correction of the value on the tax rolls indicated in the attachment to this order.
The basis of this agreement is:
Sale of the subject property
Physical appraisal of the property
Clerical error
Change in property (fire, flood, landslide, demolition, etc.)
Other (explain): ________________________________________________________________________________
________________________________________________________________________________
______________________________
______________________________
______________________________
Taxpayer or Representative (print or type)
Taxpayer or Representative (print or type)
County Officer (print or type)
________________________________________
________________________________________
________________________________________
Title (if applicable)
Title (if applicable)
Title (if applicable)
X
X
X
________________________________________
________________________________________
________________________________________
Signature of Taxpayer or Representative
Signature of Taxpayer or Representative
Signature of County Officer
________________________________________
________________________________________
________________________________________
Date
Date
Date
The parties have entered into a stipulation in this matter. The stipulation properly reflects the value of the property
as agreed to in the attachment to this order. Jurisdiction is provided by ORS 306.115. The appropriate county officers
shall correct the tax roll(s) in conformity with the stipulation in this matter. Any excess taxes paid shall be refunded
with interest pursuant to ORS 311.806 and ORS 311.812.
IT IS SO ORDERED.
Dated and mailed at Salem, Oregon this ______ day of ____________________ , 20 ______.
150-303-065 (Rev. 03-11)
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