Form 150-310-079 - Application For Protection By Rural Fire Protection District
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APPLICATION FOR FIRE PROTECTION BY A RURAL FIRE PROTECTION DISTRICT
On forestland included within a forest protection district under ORS 477.205 to 477.281 as provided by ORS 478.140
TO: __________________________________________________________ Rural Fire Protection District
R.F.P. DISTRICT USE ONLY
ASSESSOR’S USE ONLY
Enter Name and Address below
Date Received
Approved
Date Received
Approved
INSTRUCTIONS TO APPLICANT
1. Applicant must own the property or be purchasing it under contract.
2. File separate application for each tax account.
3. File original form with the Rural Fire Protection District in which your
property is located.
4. Retain a copy for your files.
INSTRUCTIONS TO RURAL FIRE PROTECTION DISTRICT
1. Forward a copy to the assessor of the county in which the property is
Telephone Number: ____________________________________
located within 20 days of receipt from applicant.
PROPERTY DESCRIPTION
c Deed or c Contract
Deed Volume and Page or Instrument Number: _________________ Date Recorded: ______________
_______________________ County
Account Number (as shown on your tax statement): ______________________________
Section
Township
Section Subdivision or Name of Addition
Range
Acres
or Lot
or Block
I, as owner, hereby request that part of the above-described property which is protected against fire by the State Board of Forestry
under the provisions of Oregon Revised Statute (ORS) 477.205 to 477.281, also be protected against fire by the rural fire protection
district in which it is located.
1. This property is located within the exterior boundaries of the above-named Rural Fire Protection District and a forest protection
district as defined in ORS 477.205 to 477.281.
2. I understand that I will be taxed for fire protection on the county tax roll by both the rural fire protection district and by the State Board
of Forestry under ORS Chapter 477.
DECLARATION
I declare under the penalties for false swearing as contained in ORS 305.990(4) that this document has been examined by me and to
the best of my knowledge it is a true, correct, and complete statement.
Applicant’s Signature
Date
X
150-310-079 (Rev. 4-06)
RFPD—Original; Applicant—Make copy
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