DTE Form 26 (Revised 11/97) RC 319.38 Application No. _______ DATE RECEIVED APPLICATION FOR VALUATION DEDUCTION FOR DESTROYED OR DAMAGED REAL PROPERTY ANSWER ALL QUESTIONS AND TYPE OR PRINT ALL INFORMATION READ INSTRUCTIONS ON BACK BEFORE COMPLETING FORM Please return to: GEAUGA COUNTY AUDITOR 231 Main Street-Annex Chardon, OH 44024-1293 1. OWNER'S NAME 2. OWNER'S ADDRESS CITY/STATE 3. OWNER'S TELEPHONE NUMBER ( ) ZIP 4. PARCEL NUMBER OF DAMAGED PROPERTY 5. ADDRESS OF DAMAGED PROPERTY CITY/STATE 6. COUNTY WHERE LOCATED 7. DATE DAMAGE OCCURRED 8. CAUSE OF DAMAGE 9. DESCRIPTION OF DAMAGE ZIP 10. ESTIMATED DOLLAR AMOUNT OF DAMAGE $ 11. IF PROPERTY INSURED, AMOUNT OF INSURANCE RECEIVED $ I declare under penalties of perjury that this application has been examined by me and, to the best of my knowledge and belief, it is true, correct and complete. OWNER Signature Sworn to and signed in my presence, this __________ day of _________________, ______. DATE Notary Public American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS FOR COMPLETING FORM FILING DEADLINES AND SCHEDULE OF DEDUCTIONS: An application for a deduction from the current year's value must be filed by December 31 for property that is destroyed or damaged in the first nine months of the year. For property damaged in the last three months of the year, the filing deadline is January 31 of the following year. Any deduction from value approved will affect the tax bills due the following year. The amount of the deduction equals a percentage of the reduction in value caused by the damage or destruction. That percentage is determined by the calendar quarter in which the damage occurred. The filing deadline and percentage deduction allowed for each calendar quarter are shown below. CALENDAR QUARTER IN WHICH PROPERTY WAS DAMAGED JANUARY - MARCH APRIL - JUNE JULY - SEPTEMBER OCTOBER - DECEMBER LINE INSTRUCTIONS: LINES 1, 2 and 3: LINE 4: LINE 5: LINE 6: LINE 7: LINE 8: LINE 9: LINE 10: LINE 11: Enter owner's full name, mailing address, and daytime phone number. Enter parcel number(s) of damaged property. This number is shown on your tax bill. Enter the full address of the damaged property. Enter name of county where damaged property is located. Enter date the damage or destruction occurred. Explain cause of damage: fire, flood, intentional demolition, etc. Describe the damage to the property, attach additional pages if necessary. Enter your best estimate of the reduction in the property's value caused by the damage. If property is insured, show the amount the insurance company paid or will pay, if available. PERCENTAGE DEDUCTION ALLOWED 100% 75% 50% 25% APPLICATION DEADLINE DECEMBER 31 DECEMBER 31 DECEMBER 31 JANUARY 31 OWNER'S SIGNATURE: Sign and date the application at the bottom and have your signature notarized. If the owner's signature is not notarized, the section below must be completed and notarized. AFFIDAVIT OF TWO DISINTERESTED PERSONS If the owner's signature is notarized on the front of this application, this affidavit is not necessary. and being duly sworn, say that they are residents of the municipal corporation or township in which the above property is or was situated, that neither of them has any interest therein, and that property was destroyed or injured on the date shown above. Signed Sworn to and signed in my presence, this _____ day of _________________, ________. DTE Form 26 (Revised 11/97) Notary Public American LegalNet, Inc. www.FormsWorkFlow.com