SOLD! 16747 Old Military Sisters by Suzanne Carvlin, Principal Broker, Licensed in Oregon

16747 OLD MILITARY DRIVE SISTERS, OREGON 97759

www.OldMilitar ySisters.com

PROPERTY DETAILS

16747 OLD MILITARY DRIVE SISTERS, OR | MLS# 201905205

3 BD

2.5 BA

31 AC

3,567 SF

$1,447,000

3,567 total SF with 2,942 SF on main level Office & Bonus/Rec Room 5-Stall, 4,000 SF Barn 12’x16’ Workshop 750 SF Ranch Hand Quarters 10 Irrigated Acres Fenced & Cross-Fenced Equestrian Riding Area RV Parking & Hook-ups Double-Car Attached Garage Built by Owner with an Accepted Offer

www.OldMilitarySisters.com

Located in the exclusive Old Military neighborhood of Sisters, Oregon, this southwest-style hacienda on 31-acres is a quiet respite and getaway retreat. North-east exposure and a view of Mt. Jefferson plus acres of lush pastures.

Whether relaxing, entertaining guests, grazing cattle or riding horses, you will find this property has everything that you need. This peaceful and quiet private neighborhood has a private road maintained by neighbors. Enjoy lounging on one of your private patios while you bask in the morning sun and enjoy the fresh air.

The 3,567 SF main home features an open layout with main level living plus an upstairs bonus room. Immediately, you are welcomed into the open living area with a stacked rock wood-burning fireplace (also plumbed for propane), a vaulted pine ceiling, solid oak floors, ironwork staircase, post & beam accents, and a spacious floor plan.

Designed with entertaining in mind, Old Military has great guest flow throughout the home. With 20foot ceilings and amazing acoustics, play music from the balcony above the great room & kitchen. The kitchen features a stunning rustic art candelabra, custom cabinetry, new granite slab counters, a copper clad tile backsplash, center island and a bar counter. Appliances include a 6-burner propane range with self-exhaust cooktop and grill, a double oven, warming drawer, refrigerator, and dishwasher, and a large pantry with custom built-ins provides ample storage.

Multiple dining spaces provide areas to entertain, mix and mingle, or simply enjoy your morning coffee. Quality craftsmanship includes distressed oak & Spanish-style tile floors, solid alder doors, wood casement windows, exposed beams and painted Mexican tile accents.

With a focus on outdoor living, the covered patio features a stucco wood fireplace and stucco half-wall surround with a wagon-wheel accent. The southeast patio orientation allows for sunny afternoons and shaded evenings to linger outside late into the night.

Southwest style saloon doors access the office. From here, you can organize your day, watch a game on the flush mounted TV, enjoy a fire in the propane fireplace, and unwind.

The 5-foot wide hallway with exposed beams allows for ease of mingling of guests. Multiple art nooks with shadow boxes highlight your collection.

The master bedroom has a niche for a dresser and TV as well as recessed lighting on dimmer switches. Barn doors lead to the walk-in closet with custom built-ins and the master bath with a Jacuzzi tub with jets, a tile shower, and tiled vanity. Enjoy the sunset from your own master suite private paver patio with a view of the pastures and Mt. Jefferson. Access the outdoor hot tub situated to capture the views and the water feature and pond.

Two guest bedrooms share a full guest bath with marble tile countertops. An additional guest bath features an antique dresser vanity with a copper hammered sink.

Upstairs, the 625 SF bonus recreation room has a solid oak entertainment center with built-ins that creates privacy in the bonus area and houses the TV, media equipment, books, games and more. The iron balustrade and interior balcony overlook the great room & kitchen, the perfect place to serenade guests as they arrive for an evening of friends and entertainment.

Rendering of Double-Car Attached Garage, Build by Seller with an Accepted Offer.

A 4,000 SF Barn has 5 stalls, paddock, tack room, 12â&#x20AC;&#x2122; x 16â&#x20AC;&#x2122; workshop, hay & equipment storage, and parking for multiple RVs plus hook-ups. The ranch hand quarters includes a gathering area, loft, kitchenette, and full bath. The landscaping naturally blends in with the surrounding environment with 2 ponds, a water feature, fenced irrigated pastures & equestrian riding area.

26 acres are zoned Exclusive Farm Use Sisters/Cloverdale, include 10 Irrigated acres (5 acres water permit, 5 leased annually) and are ideal for horses, livestock including cattle, sheep, chickens & fowl. Property is already set up with fenced and cross-fenced pastures and a chicken coop.

A 360-degree view of open terrainsoffers offersaaview viewof of Mt. Mt. Jefferson Jefferson from house, Black Butte & & A 360-degree view of open terrains fromthe themain main house, Black Butte ThreeSisters Sistersviews views from from the and no no view of neighbors. It is common to seeto mule Three theeast eastofofthe theproperty property and view of neighbors. It is common seedeer mule A 360-degree view of open terrains offers a view of Mt. Jefferson from the main house, Black Butte & and other nativearound wildlife the frolicking around the property. deer and other native wildlife frolicking property. Three Sisters from the east to of several the property and no view of neighbors. It is common see mule deer Benefitviews from nearby access preserve areas maintained by the Deschutes LandtoTrust. Benefit from nearby access to several preserve areas maintained by the Deschutes Land Trust. From Old Military, you 5 miles andwildlife just minutes from around Camp Polk Hwy 126, taking you to Sisters, andare other native frolicking theand property. Redmond Bendyou shopping, dining downtown events. From Oldand Military, are 5 miles and & just minutes from Camp Polk and Hwy 126, taking you to Sisters, Benefit from nearby access to several preserve areas maintained by events. the Deschutes Land Trust. Redmond and Bend shopping, dining & downtown

From Old Military, you are 5 miles and just minutes from Camp Polk and Hwy 126, taking you to Sisters,

ZONING MAPS

Deschutes County Property Information - Dial Zoning Map for account 131293

Source: Esri, DigitalG lobe, GeoEye, Earthstar Geographics, CNES/Airbus DS, USDA, USGS, AeroGRID, IGN, and the GIS User Community, Deschutes County GIS

Map and Taxlot: 141036B002700

Deschutes County Property Information - Dial Zoning Map for account 131293

Source: Esri, DigitalG lobe, GeoEye, Earthstar Geographics, CNES/Airbus DS, USDA, USGS, AeroGRID, IGN, and the GIS User Community, Deschutes County GIS

Map and Taxlot: 141036B002700

Deschutes County Property Information - Dial Zoning Map for account 205848

Deschutes County GIS, Source: Esri, DigitalGlobe, GeoEye, Earthstar Geographic s, CNE S/Airbus DS, US DA, USGS, AeroGRID, IGN, and the GIS User Community

Map and Taxlot: 1410350000105

Deschutes County Property Information - Dial Zoning Map for account 131293

Source: Esri, DigitalG lobe, GeoEye, Earthstar Geographics, CNES/Airbus DS, USDA, USGS, AeroGRID, IGN, and the GIS User Community, Deschutes County GIS

Map and Taxlot: 141036B002700

LOCAL ATTRACTIONS

DETAIL LIST

16747 Old Military Drive Sisters, Oregon 97759

3 Tax Accounts 1. Account: 205848 Situs Address: 16747 OLD MILITARY DR, SISTERS, OR 97759 Map and Taxlot: 1410350000105 Property Tax (Current Year): $4,891.37 Assessor Acres: 5.00 Zoning: EFSCU – Exclusive Farm Use – Sisters Cloverdale Subzone No HOA, No CC&Rs Deed restrictions, see attachments

2. Account: 190971 Situs Address: 16747 OLD MILITARY DR, SISTERS, OR 97759 Map and Taxlot: 1410350000105 Property Tax (Current Year): $1,665.97 Assessor Acres: 20.70 Zoning: EFSCU – Exclusive Farm Use – Sisters Cloverdale Subzone No HOA, No CC&Rs Deed restrictions, see attachments

3. Account: 131293 Situs Address: 69565 PINE RIDGE DR, SISTERS, OR 97759 Map and Taxlot: 141036B002700 Property Tax (Current Year): $899.54 Assessor Acres: 5.30 PANORAMIC VIEW ESTATES Lot 2 Block 1 Zoning: RR10 – Rural Residential 10-acre Minimum 5- acres is used as the legal lot of record for entire property and is not divisible or buildable No HOA, Yes CC&Rs for Panoramic View Estates

16747 Old Military Drive, Sisters, Oregon 97759 Page 1 of 9

16747 Old Military Drive Sisters, Oregon 97759

View of Mt. Jefferson • From east of property, view Three Sisters & Black Butte • 360 degree open terrain views with no view of neighbors • Main Patio with southeast orientation for sunny afternoons and shaded non-glare evenings

Architects: Jim Klemz & Joe Swank

Builder: Harry Ferris Building and Design • • • • • • • • •

3,567 Square Feet Single-level with upstairs 625 SF bonus & rec room (2,942 on main level) Built 2006 3 Bedrooms 2.5 Baths Office Stem wall foundation 31 Total acres with 10 irrigated acres (5 acres water permit, 5 leased annually) Home exterior repainted 2017 (Sherwin Williams Duration) 3 Tax Accounts

Property Features • Exclusive neighborhood with private paved road access • Small working ranch with production capacity and recreational features • Water feature • 2 lined ponds (1 concrete lined for irrigation and 1 lined with 30 mil black plastic pond liner for decoration) • 5 stall, 4,000 square foot barn with tack room, finished shop and 750 +/- SF ranch hand quarters • Full RV parking with hook-ups near barn • Equestrian cross-country riding area set up on property • Outdoor fenced arena • Property is fenced and cross-fenced • Gravel circular driveway to main house and barn • Access roads to rear of pastures

16747 Old Military Drive, Sisters, Oregon 97759 Page 2 of 9

Construction & Architectural Details • Elevated home site • Wood casement Eagle windows, wood frame inside, aluminum clad outside • Beamed accents over windows with Mexican tile accents • Rock ledge exterior window sills • 12-inch thick east wall • Traditional 3-coat stucco exterior • Distressed oak wood & Spanish terra cotta-style tile floors • Solid Alder wood doors • Arched passageways • Art niches and alcoves • Ornamental wrought iron work and railings • Vaulted ceilings • Exposed beams • Spanish Colonial style red barrel concrete composite tile 40-year roof • Rock work by Kevin Spencer Masonry • Builder, Harry Ferris Building and Design

Neighborhood & Access • Old Military Drive – Private paved road with shared maintenance road agreement • 1 mile to access Camp Polk Meadow Preserve o 151 acre Camp Polk Meadow Preserve including the Hindman Springs area and a gravel-walking trail protected by the Deschutes Land Trust. Spring wildflowers, birding hot spot, and spectacular seasonal colors. Wetlands, meadow, aspen groves and pine stands. • 1 mile to access Willow Springs Preserve o 130- acre preserve along Whychus Creek with guided tours. Willow-lined Whychus Creek, cottonwood and aspen stands with creek side meadows. Rim rock cliffs, brilliant seasonal colors along Whychus Creek • 2 miles to access Aspen Hollow Preserve o Nesting golden eagles along Whychus Creek with rim rock cliffs • 3.2 miles from Aspen Lakes Golf Course including clubhouse, restaurant and 18 holes with iconic red sand cinder bunkers • 5.1 miles to the western town of Sisters, including shopping, restaurants and events • 21 miles to Redmond Municipal Airport • 21 miles to the city of Bend, Oregon • 26 miles to Hoodoo Ski Area: skiing, cross-country, night skiing, tubing, sledding • 45.4 miles to Mt. Bachelor Ski Resort: skiing, alpine, Nordic, biking, tubing, sledding and rafting

16747 Old Military Drive, Sisters, Oregon 97759 Page 3 of 9

Main Home with Single-Level Floor Plan plus Bonus Room

Main Level

Entry •

Arched custom alder front door

Great Room • Wood-burning fireplace (also plumbed for propane) with stacked rock hearth and wood mantle • Distressed solid oak wood floors • Vaulted tongue and groove pine & beamed ceiling • Ironwork staircase and balcony railing

Dining Room • Formal dining room • Dining area comfortably seats 8 - 10 • Spanish terra cotta-style tile floors • Wood casement windows • Arched passageways • Access to outdoor patio through French doors

Kitchen • 20-foot vaulted ceilings with clerestory windows • New granite slab countertops with copper clad tile backsplash • Under cabinet lighting • Center island with breakfast bar • Breakfast bar seats 4 • Ironwork staircase and balcony railing • Antique ironwork sculpture chandelier • Appliances, including: o 6-burner propane range with self exhaust cooktop and grill o Refrigerator o Double oven with warming drawer o Microwave o Dishwasher o No disposal – scraps go to compost & chickens • Pantry with double-doors and custom built-ins

Breakfast nook • Wall of windows overlooking paver patio and pastures • Sliding doors with access to patio • Leads to kitchen, hallway and utility area

16747 Old Military Drive, Sisters, Oregon 97759 Page 4 of 9

Hallway • 6-foot wide hallway for ease of access • Exposed wood beam Vega ceiling • Multiple Art niches, two backlit with halogen lighting • Distressed solid oak wood floors • Alcove leading to bedrooms • 2 hall closets for storage • Hall closet underneath staircase houses entertainment equipment

Guest Half Bath • Antique dresser converted into vanity • Copper hammered sink • Commode • EXCLUDED: Vanity mirror above sink

Office • • • • • • •

Hand made southwest style saloon doors to office Propane fireplace Nook for audio visual equipment (hooked up in under staircase storage area) Wired with surround sound Carpeted floor View of Mt. Jefferson EXCLUDED: Custom wood cabinets

Guest Bedroom 1 – Junior Master Suite • Mirrored closet doors • Built-in desk • Window blinds • Carpeted floor • Direct access to Jack & Jill bath • Backyard view

Guest Bedroom 2 • Walk-in closet • Carpeted floor • Direct access to Jack & Jill bath • Backyard view

Guest Full Bath • Jack & Jill to both guest bedrooms • Fiberglass shower & tub • Marble tile countertops • Tiled floor • Linen closet 16747 Old Military Drive, Sisters, Oregon 97759 Page 5 of 9

Master Bedroom with EnSuite • Private patio with sliding doors and hot tub access • Windows flanking king size bed • Niche for dresser and TV • Recessed lighting on dimmer and remote wireless switches • Barn trolley doors to master bath • Carpeted floor • View of Mt. Jefferson

Master Bath • Walk-in closet with custom built-ins • Jacuzzi tub with jets • Tile shower with glass door • Tile vanity • Tiled floor • EXCLUDED: Vanity mirror above sink

Utility Room • Washer/dryer hook-ups • Cherry cabinets • Furnace • Hot water heater • Access to outside • EXCLUDED: Main house washer and dryer

Upper Level

Bonus & Recreation Room • 625 square feet of bonus and recreation area • Wrought iron balustrade with interior balcony overlooking great room & kitchen • Exterior balcony overlooking natural landscaping • Solid pine entertainment center with built-ins creates privacy in the bonus area and houses TV, media equipment, books, games and more • Ideal for movie room, game room • Potential to expand square footage if needed, or to add a 4th bedroom and full bath.

Heating & Cooling Heating & cooling provided by: • Whole house furnace • Trane heat pump • Wood burning fireplace in great room • Propane fireplace in office

16747 Old Military Drive, Sisters, Oregon 97759 Page 6 of 9

Garage â&#x20AC;˘ With an accepted offer, garage plans are Included and construction of the garage will start upon acceptance of an offer and be completed within 3 months â&#x20AC;˘ Plans are designed for: o Single level, double-car garage with two single-car wood garage doors o Covered breezeway connection to the main house through the utility room o Same finishes as main home including stucco exterior, Spanish tiled roof, decorative end cut eves, decorative capitals, window header detail, & rock window ledge o Concrete slab foundation o Milgard windows

16747 Old Military Drive, Sisters, Oregon 97759 Page 7 of 9

Exterior

Outdoor Living Space • Hot tub • Multiple paver patios and walkways • Built-in chimenea-style wood-burning fireplace • Stucco patio privacy half-wall with wagon-wheel décor • Natural landscaping and lawn with flower beds on sprinkler system, freshly mulched • Decorative pond with water feature near main home plus irrigation pond • Pastures, fenced and cross-fenced • Planted raised garden beds with a fenced area

Chicken Coop • Coop with run

Full RV Hook Ups • Space for multiple coach parking

Barn with Shop Area and Ranch Hand Quarters • Tack room • 5 Stalls, 12 x 12 feet • Large paddock area with gates to fields • Concrete floors down main aisle of barn • Upper loft storage • Frost free stand pipes • EXCLUDED: Personal license plate collection

Workshop in Barn • 12 x 16 +/- workshop • Built-in cabinets for storage • Insulated and finished • Window for view • Concrete floor • Access to barn

Ranch Hand Quarters • 750 + / - SF • Access to barn through hallway and upstairs loft • Access to outdoors from main level • Main level room • Closet with property equipment (see below) • Wood stove & wall heat • Full bath with fiberglass stall shower, vanity and commode o Access to hallway and main level room 16747 Old Military Drive, Sisters, Oregon 97759 Page 8 of 9

•

Utility area with kitchenette includes: o Built-in cabinets o Washer & dryer o Utility Sink o Microwave Upstairs loft space with blue & buggy pine wood walls

Equipment Closet (Located in Barn Ranch Hand Quarters) • 2 pressure tanks • Irrigation and well pump VSD control panel • Water heater • Wall heater for room temperature control

Private Well & Irrigation • Well Log • 10 Irrigated acres (5 acres water permit, 5 leased annually) • Underground irrigation set to 3 phases • 2016 well pump 15-horse power variable speed pump – 35 gallons per minute • Irrigation pond with automatic fill • Irrigation controller with 8 zones and hand valve splits • 5 horse power irrigation pump • 2 pressure tanks

Road Maintenance Agreement • See attached

Exclusive Farm Use Sisters/Cloverdale Zoning Ideal for: • Horses • Cattle • Sheep • Chickens & fowl • See zoning outright uses and conditional uses

On-site Septic System • Septic Map

Survey map • See attached plot plan and survey map. Subject property is parcel B + 5 acres in Panoramic Estates Floor Plans • Seller built home and has floor plans

16747 Old Military Drive, Sisters, Oregon 97759 Page 9 of 9

FLOOR PLAN

GARAGE ADDITION

COUNTY TAX & INFO

Deschutes County Property Information Report Date: 3/11/2020 2:52:10 PM

Disclaimer The information and maps presented in this report are provided for your convenience. Every reasonable effort has been made to assure the accuracy of the data and associated maps. Deschutes County makes no warranty, representation or guarantee as to the content, sequence, accuracy, timeliness or completeness of any of the data provided herein. Deschutes County explicitly disclaims any representations and warranties, including, without limitation, the implied warranties of merchantability and fitness for a particular purpose. Deschutes County shall assume no liability for any errors, omissions, or inaccuracies in the information provided regardless of how caused. Deschutes County assumes no liability for any decisions made or actions taken or not taken by the user of this information or data furnished hereunder.

Account Summary Account Information

Ownership

Mailing Name:

Mailing Address:

KLEMZ, JAMES F & FAY B

Map and Taxlot: 141036B002700

KLEMZ, JAMES F & FAY B

Account: Tax Status:

16747 OLD MILITARY DR

Situs Address:

131293 Assessable 69565 PINE RIDGE DR, SISTERS, OR 97759

SISTERS, OR 97759 Valuation Real Market Values as of Jan. 1, 2019

Property Taxes Current Tax Year: $899.54 Tax Code Area:

6049

Assessment

Land

$260,560

Structures

Total

$260,560

Subdivision: PANORAMIC VIEW ESTATES

Current Assessed Values:

Lot:

Maximum Assessed

$66,720

Block: 1

Assessed Value

$66,720

Assessor Acres: 5.30 Property Class: 400 -- TRACT

Veterans Exemption

Warnings, Notations, and Special Assessments Assessor's Office Special Assessments

Amount

Year

DEPT OF FORESTRY FIRE PATROL TIMBER

18.75

2020

Review of digital records maintained by the Deschutes County Assessorâ&#x20AC;&#x2122;s Office, Tax Office, Finance Office, and the Community Development Department indicates that there are County tax, assessment, or property development related notations associated with this account and that have been identified above. Independent verification of the presence of additional Deschutes County tax, assessment, development, and other property related considerations is recommended. Confirmation is commonly provided by title companies, real estate agents, developers, engineering and surveying firms, and other parties who are involved in property transactions or property development. In addition, County departments may be contacted directly to discuss the information.

Valuation History All values are as of January 1 of each year. Real Market Value - Land Real Market Value - Structures Total Real Market Value

Tax year is July 1st through June 30th of each year.

2015 - 2016 $127,500 $0 $127,500

2016 - 2017 $130,050 $0 $130,050

2017 - 2018 $209,380 $0 $209,380

2018 - 2019 $213,570 $0 $213,570

2019 - 2020 $260,560 $0 $260,560

$59,300 $59,300 $0

$61,070 $61,070 $0

$62,900 $62,900 $0

$64,780 $64,780 $0

$66,720 $66,720 $0

Maximum Assessed Value Total Assessed Value Veterans Exemption

Deschutes County Property Information Report, page 1

Tax Payment History Year

Date Due

Transaction Type

Transaction Date

As Of Date

Amount Received

Tax Due

Discount Amount

Interest Charged

Refund Interest

2019

11-15-2019

PAYMENT

02-24-2020

2019

11-15-2019

PAYMENT

11-18-2019

02-15-2020

$299.84

($299.84)

$0.00

11-15-2019

$299.85

($299.85)

$0.00

2019

11-15-2019

IMPOSED

10-11-2019

11-15-2019

$0.00 Total:

$899.54 $299.85

$0.00

2018

11-15-2018

PAYMENT

05-17-2019

05-15-2019

$291.82

($291.82)

$0.00

2018 2018

11-15-2018

PAYMENT

02-20-2019

02-15-2019

$291.82

($291.82)

$0.00

11-15-2018

PAYMENT

11-20-2018

11-15-2018

$291.82

($291.82)

$0.00

2018

11-15-2018

IMPOSED

10-13-2018

11-15-2018

$0.00 Total:

$875.46 $0.00

$0.00

2017

11-15-2017

PAYMENT

01-02-2018

$562.25

($562.25)

$0.00

2017

11-15-2017

PAYMENT

11-21-2017

11-15-2017

$281.13

($281.13)

$0.00

2017

11-15-2017

IMPOSED

10-13-2017

11-15-2017

$0.00 Total:

$843.38 $0.00

$0.00

Sales History Sale Date

Seller

Buyer

Sale Amount

02/22/2005

JACOBSON,DONALD C & RUETTGERS,KENNETH F

KLEMZ, JAMES F & FAY B

$445,000

01/03/2002

RUETTGERS,KENNETH

JACOBSON,DONALD C

04/08/2001

LINDSAY,LESLIE M TRUSTEE LESLIE M LINDSA

RUETTGERS,KENNETH

$125,000

03/01/1993

LINDSAY LESLIE M ETUX

LINDSAY,LESLIE M TRUSTEE LESLIE M LINDSA

No Structures Found.

Deschutes County Property Information Report, page 2 (For Report Disclaimer see page 1)

Sale Type

Recording Instrument

35-MULTIPLE ACCOUNTS 2005-10825 INVOLVED IN SALE 06-GRANTEE IS RELATED/FRIENDS/BUSINES S ASSOCIATES 33-CONFIRMED SALE

2001-18755

08-GRANTOR/GRANTEE ARE 1993-2920104 THE SAME

Land Characteristics Land Description

Acres

Rural Lot

5.30

Land Classification

Ownership Ownership Percentage

Name Type

Name

Ownership Type

OWNER

KLEMZ, FAYB

OWNER

100.00%

OWNER

100.00%

HUSBAND AND WIFE~KLEMZ, JAMES F OWNER

KLEMZ, JAMESF HUSBAND AND WIFE~KLEMZ, FAY B

Service Providers Please contact districts to confirm. Category

Name

Phone

Address

COUNTY SERVICES

DESCHUTES COUNTY DESCHUTES COUNTY SHERIFF'S OFFICE CLOVERDALE RURAL FIRE PROTECTION DISTRICT SISTERS SCHOOL DISTRICT #6

(541) 388-6570

1300 NW WALL ST, BEND, OR 97703

(541) 693-6911

63333 HIGHWAY 20 WEST, BEND, OR 97703

(541) 548-4815

68787 GEORGE CYRUS RD, SISTERS, OR 97759

(541) 549-8521

525 EAST CASCADE AVE, SISTERS, OR 97759

SISTERS ELEMENTARY SCHOOL

(541) 549-8981

611 EAST CASCADE AVE, SISTERS, OR 97759

SISTERS MIDDLE SCHOOL

(541) 549-2099

15200 MCKENZIE HWY, SISTERS, OR 97759

SISTERS

(541) 549-4045

1700 MCKINNEY BUTTE RD, SISTERS, OR 97759

(541) 693-5600

145 SE SALMON AVE, REDMOND, OR 97756

(541) 383-7700

2600 NW COLLEGE WAY, BEND, OR 97703

POLICE SERVICES FIRE DISTRICT SCHOOL DISTRICT ELEMENTARY SCHOOL ATTENDANCE AREA MIDDLE SCHOOL ATTENDANCE AREA HIGH SCHOOL ATTENDANCE AREA EDUCATION SERVICE TAX DISTRICT COLLEGE TAX DISTRICT PARK & RECREATION DISTRICT LIBRARY DISTRICT ROAD TAX DISTRICT GARBAGE & RECYCLING SERVICE

HIGH DESERT EDUCATION SERVICE DISTRICT CENTRAL OREGON COMMUNITY COLLEGE SISTERS PARK & RECREATION DISTRICT DESCHUTES PUBLIC LIBRARY

(541) 549-2091 (541) 617-7050

1750 W. McKINNEY BUTTE RD, SISTERS, OR 97759 601 NW WALL ST, BEND, OR 97703

PANORAMIC ACCESS ROAD DISTRICT (541) 549-3733

HIGH COUNTRY DISPOSAL

1090 NE HEMLOCK AVE, REDMOND, OR 97756

(541) 548-4984

Development Summary Planning Jursidiction: Urban Growth Boundary:

Deschutes County

County Zone

Description

RR10

RURAL RESIDENTIAL - 10 ACRE MINIMUM

Urban Reserve Area:

County Development Details Wetland (National or Local): Conservation Easement:

Not Within a Mapped Wetland

FEMA 100 Year Flood Plain: TDC/PRC Restrictive Covenant: Ground Snow Load:

Not Within 100 Year Flood Plain

No Conservation Easement Recorded No TDC/PRC Restrictive Covenant Found 36 #/sq. ft.

Deschutes County Property Information Report, page 3 (For Report Disclaimer see page 1)

Deschutes County Permits Permit ID

Permit Type

Applicant

Application Date

Status

247-LL01101-PL

Land Use

DON JACOBSON

10/15/2001

Finaled

247-CU0539-PL

Land Use

JAMES F. KLEMZ

04/27/2005

Finaled

247-D0514-PL

Land Use

JAMES F. KLEMZ

03/10/2005

Finaled

Deschutes County Property Information Report, page 4 (For Report Disclaimer see page 1)

STATEMENT OF TAX ACCOUNT DESCHUTES COUNTY TAX COLLECTOR DESCHUTES SERVICES BUILDING BEND OR 97703 (541) 388-6540 11-Mar-2020 KLEMZ, JAMES F & FAY B 16747 OLD MILITARY DR SISTERS, OR 97759 Tax Account # Account Status Roll Type Situs Address

131293 A Real 69565 PINE RIDGE DR SISTERS 97759

Lender Name Loan Number 6049 Property ID Interest To Mar 11, 2020

Tax Summary Tax Year 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996

Tax Type ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM Total

Total Due

Current Due

Interest Due

Discount Available

$299.85 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$299.85

$0.00

Deschutes County Property Information Report, page 5 (For Report Disclaimer see page 1)

Original Due $899.54 $875.46 $843.38 $832.98 $779.12 $756.85 $735.95 $725.00 $704.51 $709.87 $687.49 $672.77 $641.55 $599.10 $588.02 $572.34 $536.15 $523.21 $516.85 $469.95 $457.00 $449.39 $445.04 $495.75

Due Date Nov 15, 2019 Nov 15, 2018 Nov 15, 2017 Nov 15, 2016 Nov 15, 2015 Nov 15, 2014 Nov 15, 2013 Nov 15, 2012 Nov 15, 2011 Nov 15, 2010 Nov 15, 2009 Nov 15, 2008 Nov 15, 2007 Nov 15, 2006 Nov 15, 2005 Nov 15, 2004 Nov 15, 2003 Nov 15, 2002 Nov 15, 2001 Nov 15, 2000 Nov 15, 1999 Nov 15, 1998 Dec 15, 1997 Nov 15, 1996

REAL PROPERTY TAX STATEMENT

TAX ACCOUNT

JULY 1, 2019 TO JUNE 30, 2020 DESCHUTES COUNTY, OREGON 1300 NW WALL ST STE 203, BEND, OR 97703 dial.deschutes.org

131293 SCHOOL DISTRICT #6 SCHOOL #6 LOCAL OPTION HIGH DESERT ESD COCC

273.53 50.04 6.43 41.39 371.39

EDUCATION TOTAL: DESCHUTES COUNTY COUNTY LIBRARY COUNTYWIDE LAW ENFORCEMENT RURAL LAW ENFORCEMENT COUNTY EXTENSION/4H 9-1-1 SISTERS PARK & RECREATION DIST SISTERS PARK & REC LOCAL OPTION PANORAMIC ACCESS ROAD DISTRICT

131293

KLEMZ, JAMES F & FAY B 16747 OLD MILITARY DR SISTERS, OR 97759

PROPERTY DESCRIPTION CODE: 6049

MAP: 141036-B0-02700

GENERAL GOVT TOTAL:

CLASS: 400

SITUS ADDRESS: 69565 PINE RIDGE DR SISTERS LEGAL: PANORAMIC VIEW ESTATES 1 2 LAST YEAR

THIS YEAR

213,570 0 213,570

260,560 0 260,560

MAXIMUM ASSESSED VALUE

64,780

66,720

TOTAL ASSESSED VALUE

64,780

66,720

VETERAN'S EXEMPTION NET TAXABLE:

0 64,780

0 66,720

TOTAL PROPERTY TAX:

875.46

899.54

VALUES: REAL MARKET (RMV) LAND STRUCTURES TOTAL RMV

TAX QUESTIONS ASSESSMENT QUESTIONS dial.deschutes.org

81.28 36.70 72.06 89.40 1.49 24.14 14.68 10.01 79.13 408.89

(541) 388-6540 (541) 388-6508

DEPT OF FORESTRY FIRE PATROL SCHOOL #6 BOND 2001 SCHOOL #6 BOND 2016 C O C C BOND

18.75 66.37 26.85 7.29 119.26

BONDS - OTHER TOTAL:

***FULL PAYMENT*** (Includes Discount and any Pre-payments)

872.55

Please include this coupon with payment. NO STAPLES, PAPER CLIPS, OR TAPE

Payment is Due November 15, 2019 Please select payment option below: 3% Discount 2% Discount Trimester Option

872.55 587.70 299.85

No Additional Payment Due Next Payment Due: 05/15/20 Next Payment Due: 02/18/20

DISCOUNT IS LOST & INTEREST APPLIES AFTER DUE

TAX ACCOUNT

Mailing address change on back

131293 AMOUNT ENCLOSED

$ MAKE PAYMENT TO: DESCHUTES COUNTY TAX COLLECTOR OR PAY ONLINE AT: DESCHUTES.ORG/TAX

KLEMZ, JAMES F & FAY B 16747 OLD MILITARY DR SISTERS, OR 97759

09100001312930000029985000005877000000872556 Deschutes County Property Information Report, page 6 (For Report Disclaimer see page 1)

Deschutes County Property Information Report, page 7 (For Report Disclaimer see page 1)

Deschutes County Property Information - Dial Road Map

Deschutes County GIS

Map and Taxlot: 141036B002700

Deschutes County Property Information Report, page 8 (For Report Disclaimer see page 1)

Deschutes County Property Information Report Date: 3/11/2020 2:52:58 PM

Account Summary Account Information

Ownership

Mailing Name:

Mailing Address:

KLEMZ, JAMES F & FAY B

Map and Taxlot: 1410350000105

KLEMZ, JAMES F & FAY B

Account: Tax Status:

16747 OLD MILITARY DR

Situs Address:

190971 Assessable 16747 OLD MILITARY DR, SISTERS, OR 97759

SISTERS, OR 97759 Valuation Real Market Values as of Jan. 1, 2019

Property Taxes Current Tax Year: $1,665.97 Tax Code Area:

6002

Assessment

Land

$676,740

Structures

Total

$676,740

Subdivision:

Current Assessed Values:

Lot:

Maximum Assessed

$138,650

Block:

Assessed Value

$138,650

Assessor Acres: 20.70 Property Class: 470 -- TRACT

Veterans Exemption

Warnings, Notations, and Special Assessments Review of digital records maintained by the Deschutes County Assessorâ&#x20AC;&#x2122;s Office, Tax Office, Finance Office, and the Community Development Department indicates that there are no special tax, assessment or property development related notations associated with this account. However, independent verification of the presence of other Deschutes County tax, assessment, development, and additional property related considerations is recommended. Confirmation is commonly provided by title companies, real estate agents, developers, engineering and surveying firms, and other parties who are involved in property transactions or property development. In addition, County departments may be contacted directly to discuss the information.

Valuation History All values are as of January 1 of each year. Real Market Value - Land Real Market Value - Structures Total Real Market Value

Tax year is July 1st through June 30th of each year.

2015 - 2016 $494,070 $0 $494,070

2016 - 2017 $494,070 $0 $494,070

2017 - 2018 $607,710 $0 $607,710

2018 - 2019 $583,400 $0 $583,400

2019 - 2020 $676,740 $0 $676,740

$123,210 $123,210 $0

$126,900 $126,900 $0

$130,700 $130,700 $0

$134,620 $134,620 $0

$138,650 $138,650 $0

Maximum Assessed Value Total Assessed Value Veterans Exemption

Deschutes County Property Information Report, page 1

Tax Payment History Year

Date Due

Transaction Type

Transaction Date

As Of Date

Amount Received

Tax Due

Discount Amount

Interest Charged

Refund Interest

2019

11-15-2019

PAYMENT

02-24-2020

2019

11-15-2019

PAYMENT

11-18-2019

02-15-2020

$555.32

($555.32)

$0.00

11-15-2019

$555.33

($555.33)

$0.00

2019

11-15-2019

IMPOSED

10-11-2019

11-15-2019

$0.00 Total:

$1,665.97 $555.32

$0.00

2018

11-15-2018

PAYMENT

05-17-2019

05-15-2019

$540.22

($540.22)

$0.00

2018 2018

11-15-2018

PAYMENT

02-20-2019

02-15-2019

$540.22

($540.22)

$0.00

11-15-2018

PAYMENT

11-20-2018

11-15-2018

$540.23

($540.23)

$0.00

2018

11-15-2018

IMPOSED

10-13-2018

11-15-2018

$0.00 Total:

$1,620.67 $0.00

$0.00

2017

11-15-2017

PAYMENT

01-02-2018

$1,038.97

($1,038.97)

$0.00

2017

11-15-2017

PAYMENT

11-21-2017

11-15-2017

$519.49

($519.49)

$0.00

2017

11-15-2017

IMPOSED

10-13-2017

11-15-2017

$0.00 Total:

$1,558.46 $0.00

$0.00

Sales History Sale Date

Seller

Buyer

Sale Amount

02/22/2005

JACOBSON,DONALD C & RUETTGERS,KENNETH F

KLEMZ, JAMES F & FAY B

$445,000

12/11/1997

ANDERSON,LEWIS

JACOBSON,DONALD C

$525,000

12/11/1997

ANDERSON,LEWIS

JACOBSON,DONALD C

$525,000

12/12/1997 05/26/1994

POND,ELMER SUCCESSOR TRUSTEE OF BETTY CA POND,ELMER SUCCESSOR TRUSTEE OF BETTY CA

ANDERSON,LEWIS

No Structures Found.

Deschutes County Property Information Report, page 2 (For Report Disclaimer see page 1)

Sale Type 35-MULTIPLE ACCOUNTS INVOLVED IN SALE 12-DEED RESULTING FROM CONTRACT BEING PAID 35-MULTIPLE ACCOUNTS INVOLVED IN SALE 12-DEED RESULTING FROM CONTRACT BEING PAID 12-DEED RESULTING FROM CONTRACT BEING PAID

Recording Instrument 2005-10825 1999-535 1997-4730117 1997-4730106 1997-4730099

Land Characteristics Land Description

Acres

Rural Lot

20.70

Land Classification

Ownership Ownership Percentage

Name Type

Name

Ownership Type

OWNER

KLEMZ, JAMESF

OWNER

100.00%

OWNER

100.00%

HUSBAND AND WIFE~KLEMZ, FAY B OWNER

KLEMZ, FAYB HUSBAND AND WIFE~KLEMZ, JAMES F

Related Accounts Related accounts apply to a property that may be on one map and tax lot but due to billing have more than one account. This occurs when a property is in multiple tax code areas. In other cases there may be business personal property or a manufactured home on this property that is not in the same ownership as the land. Account ID

Owner Name

Record Type

205848

KLEMZ, JAMES F & FAY B

Real Property

Service Providers Please contact districts to confirm. Category

Name

Phone

Address

COUNTY SERVICES

DESCHUTES COUNTY DESCHUTES COUNTY SHERIFF'S OFFICE CLOVERDALE RURAL FIRE PROTECTION DISTRICT SISTERS CAMP SHERMAN FIRE DISTRICT SISTERS SCHOOL DISTRICT #6

(541) 388-6570

1300 NW WALL ST, BEND, OR 97703

(541) 693-6911

63333 HIGHWAY 20 WEST, BEND, OR 97703

(541) 548-4815

68787 GEORGE CYRUS RD, SISTERS, OR 97759

(541) 549-0771

301 SOUTH ELM ST, SISTERS, OR 97759

(541) 549-8521

525 EAST CASCADE AVE, SISTERS, OR 97759

SISTERS ELEMENTARY SCHOOL

(541) 549-8981

611 EAST CASCADE AVE, SISTERS, OR 97759

SISTERS MIDDLE SCHOOL

(541) 549-2099

15200 MCKENZIE HWY, SISTERS, OR 97759

SISTERS

(541) 549-4045

1700 MCKINNEY BUTTE RD, SISTERS, OR 97759

(541) 693-5600

145 SE SALMON AVE, REDMOND, OR 97756

(541) 383-7700

2600 NW COLLEGE WAY, BEND, OR 97703

POLICE SERVICES FIRE DISTRICT FIRE DISTRICT SCHOOL DISTRICT ELEMENTARY SCHOOL ATTENDANCE AREA MIDDLE SCHOOL ATTENDANCE AREA HIGH SCHOOL ATTENDANCE AREA EDUCATION SERVICE TAX DISTRICT COLLEGE TAX DISTRICT PARK & RECREATION DISTRICT LIBRARY DISTRICT GARBAGE & RECYCLING SERVICE

HIGH DESERT EDUCATION SERVICE DISTRICT CENTRAL OREGON COMMUNITY COLLEGE SISTERS PARK & RECREATION DISTRICT DESCHUTES PUBLIC LIBRARY HIGH COUNTRY DISPOSAL

(541) 617-7050

1750 W. McKINNEY BUTTE RD, SISTERS, OR 97759 601 NW WALL ST, BEND, OR 97703

(541) 548-4984

1090 NE HEMLOCK AVE, REDMOND, OR 97756

(541) 549-2091

Development Summary Planning Jursidiction:

Deschutes County

County Zone

Description

Urban Growth Boundary: Urban Reserve Area:

EFUSC

EXCLUSIVE FARM USE - SISTERS CLOVERDALE SUBZONE

Deschutes County Property Information Report, page 3 (For Report Disclaimer see page 1)

County Development Details Wetland (National or Local):

Not Within a Mapped Wetland

Conservation Easement: FEMA 100 Year Flood Plain:

No Conservation Easement Recorded

TDC/PRC Restrictive Covenant: Ground Snow Load:

No TDC/PRC Restrictive Covenant Found

Not Within 100 Year Flood Plain

36 #/sq. ft.

Deschutes County Permits Permit ID

Permit Type

Applicant

Application Date

Status

247-B59300 247-19-001158STR 247-B60992

Building

KLEMZ,JAMES F

06/20/2005

Finaled

Building

KLEMZ, JAMES F & FAY B

03/08/2019

Expired

Building

KLEMZ,JAMES F

01/10/2006

Finaled

247-E84805

Electrical

KLEMZ,JAMES F

09/12/2005

Finaled

247-E83223 247-19-001158ELEC-01 247-E87859

Electrical

KLEMZ,JAMES F

07/08/2005

Finaled

Electrical

KLEMZ, JAMES F & FAY B

03/22/2019

Expired

Electrical

KLEMZ,JAMES F

01/10/2006

Finaled

247-E87860

Electrical

KLEMZ,JAMES F

01/10/2006

Finaled

247-FS22468

Feasibility

KLEMZ,JAMES F

07/13/2005

Finaled

247-FS18174

Feasibility

JACOBSON,DON

04/23/1998

Finaled

247-CU0539-PL

Land Use

JAMES F. KLEMZ

04/27/2005

Finaled

247-D0514-PL

Land Use

JAMES F. KLEMZ

03/10/2005

Finaled

247-19-000226-AD Land Use

Harry Ferris

03/08/2019

Closed

247-M35080

Mechanical

KLEMZ,JAMES F

01/10/2006

Finaled

247-P29502

Plumbing

KLEMZ,JAMES F

01/10/2006

Finaled

247-SW6771

Road Access

KLEMZ,JAMES F

01/10/2006

Finaled

247-S54636 247-19-000199AUTH

Septic

KLEMZ,JAMES F

08/08/2005

Septic

KLEMZ, JAMES F & FAY B

03/08/2019

Finaled App Accepted/In Review

Deschutes County Property Information Report, page 4 (For Report Disclaimer see page 1)

190971 A Real 16747 OLD MILITARY DR SISTERS 97759

Lender Name Loan Number 6002 Property ID Interest To Mar 11, 2020

Tax Summary Tax Year 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996

Total Due

Current Due

Interest Due

Discount Available

$555.32 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$555.32

$0.00

Deschutes County Property Information Report, page 5 (For Report Disclaimer see page 1)

Original Due $1,665.97 $1,620.67 $1,558.46 $1,541.40 $1,433.68 $1,391.60 $1,352.20 $1,333.24 $1,294.65 $1,309.52 $1,266.74 $1,235.66 $1,179.67 $1,112.93 $297.52 $289.89 $271.08 $239.70 $237.10 $193.65 $185.78 $2,026.63 $0.19 $0.25

REAL PROPERTY TAX STATEMENT

TAX ACCOUNT

JULY 1, 2019 TO JUNE 30, 2020 DESCHUTES COUNTY, OREGON 1300 NW WALL ST STE 203, BEND, OR 97703 dial.deschutes.org

190971 SCHOOL DISTRICT #6 SCHOOL #6 LOCAL OPTION HIGH DESERT ESD COCC

568.42 103.99 13.37 86.02 771.80

EDUCATION TOTAL: DESCHUTES COUNTY COUNTY LIBRARY COUNTYWIDE LAW ENFORCEMENT RURAL LAW ENFORCEMENT COUNTY EXTENSION/4H 9-1-1 SISTERS PARK & RECREATION DIST SISTERS PARK & REC LOCAL OPTION

190971

KLEMZ, JAMES F & FAY B 16747 OLD MILITARY DR SISTERS, OR 97759

PROPERTY DESCRIPTION CODE: 6002

168.92 76.26 149.74 185.79 3.11 50.16 30.50 20.80 685.28

GENERAL GOVT TOTAL:

MAP: 141035-00-00105

CLASS: 470

SCHOOL #6 BOND 2001 SCHOOL #6 BOND 2016 C O C C BOND

SITUS ADDRESS: 16747 OLD MILITARY DR SISTERS LEGAL:

137.93 55.81 15.15 208.89

BONDS - OTHER TOTAL:

LAST YEAR

THIS YEAR

583,400 0 583,400

676,740 0 676,740

MAXIMUM ASSESSED VALUE

134,620

138,650

TOTAL ASSESSED VALUE

134,620

138,650

VETERAN'S EXEMPTION NET TAXABLE:

0 134,620

0 138,650

TOTAL PROPERTY TAX:

1,620.67

1,665.97

VALUES: REAL MARKET (RMV) LAND STRUCTURES TOTAL RMV

TAX QUESTIONS ASSESSMENT QUESTIONS dial.deschutes.org

(541) 388-6540 (541) 388-6508

***FULL PAYMENT*** (Includes Discount and any Pre-payments)

1,615.99

Please include this coupon with payment. NO STAPLES, PAPER CLIPS, OR TAPE

Payment is Due November 15, 2019 Please select payment option below: 3% Discount 2% Discount Trimester Option

1,615.99 1,088.44 555.33

No Additional Payment Due Next Payment Due: 05/15/20 Next Payment Due: 02/18/20

DISCOUNT IS LOST & INTEREST APPLIES AFTER DUE

TAX ACCOUNT

Mailing address change on back

190971 AMOUNT ENCLOSED

$ MAKE PAYMENT TO: DESCHUTES COUNTY TAX COLLECTOR OR PAY ONLINE AT: DESCHUTES.ORG/TAX

KLEMZ, JAMES F & FAY B 16747 OLD MILITARY DR SISTERS, OR 97759

09100001909710000055533000010884400001615993 Deschutes County Property Information Report, page 6 (For Report Disclaimer see page 1)

Deschutes County Property Information Report, page 7 (For Report Disclaimer see page 1)

Deschutes County Property Information - Dial Road Map

Deschutes County GIS

Map and Taxlot: 1410350000105

Deschutes County Property Information Report, page 8 (For Report Disclaimer see page 1)

Deschutes County Property Information Report Date: 3/11/2020 2:53:31 PM

Account Summary Account Information

Ownership

Mailing Name:

Mailing Address:

KLEMZ, JAMES F & FAY B

Map and Taxlot: 1410350000105

KLEMZ, JAMES F & FAY B

Account: Tax Status:

16747 OLD MILITARY DR

Situs Address:

205848 Assessable 16747 OLD MILITARY DR, SISTERS, OR 97759

SISTERS, OR 97759 Valuation Real Market Values as of Jan. 1, 2019

Property Taxes Current Tax Year: $4,891.37 Tax Code Area:

6006

Assessment

Land

$175,160

Structures

$652,590

Total

$827,750

Subdivision:

Current Assessed Values:

Lot:

Maximum Assessed

$354,530

Block:

Assessed Value

$354,530

Assessor Acres: 5.00 Property Class: 471 -- TRACT

Veterans Exemption

Warnings, Notations, and Special Assessments Assessor's Office Special Assessments

Amount

Year

DEPT OF FORESTRY FIRE PATROL TIMBER

51.64

2020

DEPT OF FORESTRY SURCHARGE

47.50

2020

Valuation History All values are as of January 1 of each year. Real Market Value - Land Real Market Value - Structures Total Real Market Value

Tax year is July 1st through June 30th of each year.

2015 - 2016 $131,030 $417,930 $548,960

2016 - 2017 $131,030 $476,440 $607,470

2017 - 2018 $158,480 $586,010 $744,490

2018 - 2019 $152,610 $562,570 $715,180

2019 - 2020 $175,160 $652,590 $827,750

$315,010 $315,010 $0

$324,460 $324,460 $0

$334,190 $334,190 $0

$344,210 $344,210 $0

$354,530 $354,530 $0

Maximum Assessed Value Total Assessed Value Veterans Exemption

Deschutes County Property Information Report, page 1

Tax Payment History Year

Date Due

Transaction Type

Transaction Date

As Of Date

Amount Received

Tax Due

Discount Amount

Interest Charged

Refund Interest

2019

11-15-2019

PAYMENT

02-24-2020

02-15-2020

$1,630.45

($1,630.45)

$0.00

2019

11-15-2019

PAYMENT

11-18-2019

11-15-2019

$1,630.46

($1,630.46)

$0.00

2019

11-15-2019

IMPOSED

10-11-2019

11-15-2019

$0.00 Total:

$4,891.37 $1,630.46

$0.00

2018

11-15-2018

PAYMENT

05-17-2019

05-15-2019

$1,588.45

($1,588.45)

$0.00

2018

11-15-2018

PAYMENT

02-20-2019

02-15-2019

$1,588.45

($1,588.45)

$0.00

2018

11-15-2018

PAYMENT

11-20-2018

11-15-2018

$1,588.45

($1,588.45)

$0.00

2018

11-15-2018

IMPOSED

10-13-2018

11-15-2018

$0.00 Total:

$4,765.35 $0.00

$0.00

2017

11-15-2017

PAYMENT

01-02-2018

$3,067.62

($3,067.62)

$0.00

2017

11-15-2017

PAYMENT

11-21-2017

11-15-2017

$1,533.81

($1,533.81)

$0.00

2017

11-15-2017

IMPOSED

10-13-2017

11-15-2017

$0.00 Total:

$4,601.43 $0.00

$0.00

Sales History Sale Date

Seller

Buyer

Sale Amount

02/22/2005

JACOBSON,DONALD C & RUETTGERS,KENNETH F

KLEMZ, JAMES F & FAY B

$445,000

Recording Instrument

Sale Type 35-MULTIPLE ACCOUNTS INVOLVED IN SALE

2005-10825

Structures Stat Class/Description

Improvement Description

110 - RESIDENCE: Other Improvements

WOOD STOVE IN ACCESSORY BUILDING.

Code Area 6006

Accessory Description WD STOVE IN ACCESSORY BLDG

Year Built Total Sq Ft 2005 Sq Ft

Stat Class/Description

Improvement Description

153 - RESIDENCE: Two story

SQ ft per plan

Deschutes County Property Information Report, page 2 (For Report Disclaimer see page 1)

Code Area 6006

0 Quantity 1

Year Built Total Sq Ft 2006

3,567

Floor Description First Floor

Comp % 100

Sq Ft 2,942

Rooms Living

Dining

Kitchen

Nook

Great

Family

Bed

Full Bath

Half Bath

Bonus

Utility

Den

Other

Floor Description Second Floor

Comp % 100

Sq Ft 625

Rooms Living

Dining

Kitchen

Nook

Great

Family

Bed

Full Bath

Half Bath

Bonus

Utility

Den

Other

Improvement Inventory DISHWASHER

LAVATORY

DOUBLE OVEN W/MICWV

ROOF - GABLE-HIP

DRYWALL

ROOF CVR - CONC/CLAY TILE

FOUNDATION - CONCRETE

2,942

1 1 2,942

SELF EXHAUST CKTP/GRILL

FULL BATH

SHOWER WDOOR, TILE

GARBAGE DISPOSAL

SIDING - STUCCO

GAS FIREPLACE

SINGLE FIREPLACE

HALF BATH

TILE FLOOR

HARDWOOD FLOOR

TOILET

WATER HEATER

WINDOWS - DOUBLE/THERMAL PANE

WINDOWS - VINYL

HEAT PUMP/MINI SPLIT

2,942

HEAT PUMP/MINI SPLIT

313

JET TUB

KITCHEN SINK

Accessory Description PAVERS

Sq Ft 1,000

ROOF EXT. AVERAGE

Quantity

575

ROOF EXT. EXCELLENT

Stat Class/Description

Improvement Description

308 - FARM BLDG: Hobby Barn

Hobby Barn - CLASS 6

Floor Description Building Structure

Code Area 6006 Comp % 100

Year Built Total Sq Ft 2005

3,840

Sq Ft 3,840

Land Characteristics Land Description

Acres

Rural Lot

5.00

Land Classification

Ownership Ownership Percentage

Name Type

Name

Ownership Type

OWNER

KLEMZ, JAMESF

OWNER

100.00%

OWNER

100.00%

HUSBAND AND WIFE~KLEMZ, FAY B OWNER

KLEMZ, FAYB HUSBAND AND WIFE~KLEMZ, JAMES F

Deschutes County Property Information Report, page 3 (For Report Disclaimer see page 1)

Account ID

Owner Name

Record Type

190971

KLEMZ, JAMES F & FAY B

Real Property

Service Providers Please contact districts to confirm. Category

Name

Phone

Address

COUNTY SERVICES

DESCHUTES COUNTY DESCHUTES COUNTY SHERIFF'S OFFICE CLOVERDALE RURAL FIRE PROTECTION DISTRICT SISTERS CAMP SHERMAN FIRE DISTRICT SISTERS SCHOOL DISTRICT #6

(541) 388-6570

1300 NW WALL ST, BEND, OR 97703

(541) 693-6911

63333 HIGHWAY 20 WEST, BEND, OR 97703

(541) 548-4815

68787 GEORGE CYRUS RD, SISTERS, OR 97759

(541) 549-0771

301 SOUTH ELM ST, SISTERS, OR 97759

(541) 549-8521

525 EAST CASCADE AVE, SISTERS, OR 97759

SISTERS ELEMENTARY SCHOOL

(541) 549-8981

611 EAST CASCADE AVE, SISTERS, OR 97759

SISTERS MIDDLE SCHOOL

(541) 549-2099

15200 MCKENZIE HWY, SISTERS, OR 97759

SISTERS

(541) 549-4045

1700 MCKINNEY BUTTE RD, SISTERS, OR 97759

(541) 693-5600

145 SE SALMON AVE, REDMOND, OR 97756

(541) 383-7700

2600 NW COLLEGE WAY, BEND, OR 97703

HIGH DESERT EDUCATION SERVICE DISTRICT CENTRAL OREGON COMMUNITY COLLEGE SISTERS PARK & RECREATION DISTRICT DESCHUTES PUBLIC LIBRARY HIGH COUNTRY DISPOSAL

(541) 617-7050

1750 W. McKINNEY BUTTE RD, SISTERS, OR 97759 601 NW WALL ST, BEND, OR 97703

(541) 548-4984

1090 NE HEMLOCK AVE, REDMOND, OR 97756

(541) 549-2091

Development Summary Planning Jursidiction:

Deschutes County

County Zone

Description

EFUSC

EXCLUSIVE FARM USE - SISTERS CLOVERDALE SUBZONE

Urban Growth Boundary: No Urban Reserve Area: County Development Details Wetland (National or Local): Conservation Easement:

Not Within a Mapped Wetland

FEMA 100 Year Flood Plain: TDC/PRC Restrictive Covenant: Ground Snow Load:

Not Within 100 Year Flood Plain

No Conservation Easement Recorded No TDC/PRC Restrictive Covenant Found 36 #/sq. ft.

Deschutes County Property Information Report, page 4 (For Report Disclaimer see page 1)

205848 A Real 16747 OLD MILITARY DR SISTERS 97759

Lender Name Loan Number 6006 Property ID Interest To Mar 11, 2020

Tax Summary Tax Year 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002

Tax Type ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM ADVALOREM Total

Total Due

Current Due

Interest Due

Discount Available

$1,630.46 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

$1,630.46

$0.00

Deschutes County Property Information Report, page 5 (For Report Disclaimer see page 1)

Original Due $4,891.37 $4,765.35 $4,601.43 $4,534.35 $4,254.93 $3,982.81 $3,868.41 $3,817.27 $3,709.61 $3,735.40 $3,619.15 $3,556.52 $3,359.79 $602.99 $1,127.81 $1,097.24 $1,022.63 $979.94

REAL PROPERTY TAX STATEMENT

TAX ACCOUNT

JULY 1, 2019 TO JUNE 30, 2020 DESCHUTES COUNTY, OREGON 1300 NW WALL ST STE 203, BEND, OR 97703 dial.deschutes.org

205848 SCHOOL DISTRICT #6 SCHOOL #6 LOCAL OPTION HIGH DESERT ESD COCC

1,453.47 265.90 34.18 219.95 1,973.50

EDUCATION TOTAL: DESCHUTES COUNTY COUNTY LIBRARY COUNTYWIDE LAW ENFORCEMENT RURAL LAW ENFORCEMENT COUNTY EXTENSION/4H 9-1-1 CLOVERDALE FIRE DISTRICT SISTERS PARK & RECREATION DIST SISTERS PARK & REC LOCAL OPTION

205848

KLEMZ, JAMES F & FAY B 16747 OLD MILITARY DR SISTERS, OR 97759

PROPERTY DESCRIPTION CODE: 6006

MAP: 141035-00-00105

GENERAL GOVT TOTAL:

CLASS: 471

SITUS ADDRESS: 16747 OLD MILITARY DR SISTERS LEGAL: LAST YEAR

THIS YEAR

152,610 562,570 715,180

175,160 652,590 827,750

MAXIMUM ASSESSED VALUE

344,210

354,530

TOTAL ASSESSED VALUE

344,210

354,530

VETERAN'S EXEMPTION NET TAXABLE:

0 344,210

0 354,530

TOTAL PROPERTY TAX:

4,765.35

4,891.37

VALUES: REAL MARKET (RMV) LAND STRUCTURES TOTAL RMV

TAX QUESTIONS ASSESSMENT QUESTIONS dial.deschutes.org

431.92 194.99 382.89 475.07 7.94 128.27 387.29 78.00 53.18 2,139.55

(541) 388-6540 (541) 388-6508

DEPT OF FORESTRY FIRE PATROL CLOVERDALE FIRE DISTRICT BOND SCHOOL #6 BOND 2001 SCHOOL #6 BOND 2016 C O C C BOND

99.14 145.04 352.69 142.70 38.75 778.32

BONDS - OTHER TOTAL:

***FULL PAYMENT*** (Includes Discount and any Pre-payments)

4,744.63

Please include this coupon with payment. NO STAPLES, PAPER CLIPS, OR TAPE

Payment is Due November 15, 2019 Please select payment option below: 3% Discount 2% Discount Trimester Option

4,744.63 3,195.69 1,630.46

No Additional Payment Due Next Payment Due: 05/15/20 Next Payment Due: 02/18/20

DISCOUNT IS LOST & INTEREST APPLIES AFTER DUE

TAX ACCOUNT

Mailing address change on back

205848 AMOUNT ENCLOSED

$ MAKE PAYMENT TO: DESCHUTES COUNTY TAX COLLECTOR OR PAY ONLINE AT: DESCHUTES.ORG/TAX

KLEMZ, JAMES F & FAY B 16747 OLD MILITARY DR SISTERS, OR 97759

09100002058480000163046000031956900004744637 Deschutes County Property Information Report, page 6 (For Report Disclaimer see page 1)

Deschutes County Property Information Report, page 7 (For Report Disclaimer see page 1)

Deschutes County Property Information - Dial Road Map

Deschutes County GIS

Map and Taxlot: 1410350000105

Deschutes County Property Information Report, page 8 (For Report Disclaimer see page 1)

Improvement Summary For Assessment Year 2018

Account Information Owner Name:

Mailing Address:

KLEMZ, JAMES F & FAY B

Map and Taxlot: 1410350000105

KLEMZ, JAMES F & FAY B

Account: Situs Address:

16747 OLD MILITARY DR

205848 16747 OLD MILITARY DR, SISTERS, OR 97759

SISTERS, OR 97759

Structures Stat Class/Description

Improvement Description

110 - RESIDENCE: Other Improvements

WOOD STOVE IN ACCESSORY BUILDING.

Code Area

Year Built Total Sq Ft

6006

Accessory Description WD STOVE IN ACCESSORY BLDG

Stat Class/Description

Improvement Description

153 - RESIDENCE: Two story

SQ ft per plan

Code Area

Sq Ft

Quantity 1

Year Built Total Sq Ft

6006

Floor Description First Floor

2005

2006

Sq Ft 2,942

3,567

Type of Heating HEAT PUMP/MINI SPLIT

Rooms Living

Dining

Kitchen

Nook

Great

Family

Bed

Full Bath

Half Bath

Bonus

Utility

Den

Other

Floor Description Second Floor Rooms Living

Dining

Sq Ft 625 Kitchen

0 0 0 Improvement Inventory

Nook

Great

Family

Bed

Full Bath

Half Bath

Bonus

Utility

Den

Other

DISHWASHER

LAVATORY

DOUBLE OVEN W/MICWV

ROOF - GABLE-HIP

DRYWALL

ROOF CVR - CONC/CLAY TILE

FOUNDATION - CONCRETE

Type of Heating HEAT PUMP/MINI SPLIT

2,942

1 1 2,942

SELF EXHAUST CKTP/GRILL

FULL BATH

SHOWER WDOOR, TILE

GARBAGE DISPOSAL

SIDING - STUCCO

GAS FIREPLACE

SINGLE FIREPLACE

HALF BATH

TILE FLOOR

HARDWOOD FLOOR

TOILET

WATER HEATER

WINDOWS - DOUBLE/THERMAL PANE

WINDOWS - VINYL

HEAT PUMP/MINI SPLIT

2,942

HEAT PUMP/MINI SPLIT

313

JET TUB

KITCHEN SINK

Accessory Description PAVERS

Sq Ft 1,000

ROOF EXT. AVERAGE

575

ROOF EXT. EXCELLENT

Stat Class/Description

Improvement Description

308 - FARM BLDG: Hobby Barn

Hobby Barn - CLASS 6

Floor Description

Code Area 6006 Sq Ft

Quantity

Year Built Total Sq Ft 2005

3,840

Type of Heating

Building Structure

3,840

Land Characteristics Land Description

Acres

Rural Lot

5.00

Land Classification

SELLER DISCLOSURES

PLOT PLAN & DEED RESTRICTIONS

CDD COVER SHEET FOR LAM 01/ 31/ 2006 16: 55: 23

BU 3 PAGES

1 I FILE ID

1L10350000105BU20060131165523

TAXMAi

1410350000105

SERIAL

190971

DIVISION

SITUS

70015

OUSE#

CAMP

70015 30LK

STYEET

CAM>

CONTENT

SW - 6771

POLK

Community Development Department Redmond Office, 737 S. W. Cascade Ave. • Redmond, Oregon -

9775E

541) 3B5- 171 FAX 923 309; Planning Divisiol

APPLICATION FOR ACCESS -DRIVEWAY PERMIT

Building Safety Divisiol

connections to public roads or right- of-way only)

Environmental Health Divisior

Access Permit Number:

Date:

Land Use File Number ( if applicable):

5w-(©7- 1

S, g Road Number:

Road Name:

Applicant Name: Name

0..

IJWIICI (

if UIIICI diffe CIII.. rt)

Home Phone:) Permit Address:

Mailing Address ( if different): Township

Property Description: Nearest Intersection:

f '. °

Section

Tax Lot/ L)

e['

Residential

Type of Access ( check one): `

Range /

D Commercial

D Farm

Type of surface to be constructed ( check one):

D Concrete

D Asphalt

Aggregate or Cinder base

Other:

Applicant hereby applies to Deschutes County for permission to construct a driveway access at the permit address above. All work shall be in conformance with Deschutes County Code The driveway access shall be maintained as approved and shall not present a traffic hazard for road or driveway users. DCC) 17. 48. 210, 17. 48. 220 and 12. 28.

Permittee agrees and understands that this permit does not equal a land use approval. It is for access only. Any development applicable land use regulations.

of property connected with this permit must comply with all

Please include a DRA'VVING OR SITE PLAN SKETCH ( space provided on the back of this form)

showing the location and type of access. It should indicate the driveway' s position relative to Landmarks such as roads, other driveways, fence lines, power poles, etc. north arrow.

Please include a Applicant needs to mark the proposed access in the field at the road with stakes,

flagging, ribbons, or paint on the road. cess- Dnie, va

rml

Uri 9//n. l

Once the location is marked, CALL 388- 7110 scheduled as soon as practical.

FOR AN INSPECTION. Inspections will be

For properties within Unincorporated Communities, indicate

whether a curb cut and/ or sidewalks will be

required.

If required, public sidewalks shall be

constructed at the time the driveway access is constructed.

Note: If a curb cut is required for

the installation of the driveway, a permit to work in the public right- of-way is required from the County Road Department.

DISCLAIMER: Deschutes County will not take responsibility for ensuring that all other conditions of any other regulating agency

have been complied with.

It is the responsibility of the

homeowner to meet subdivision Covenants, Conditions and Restrictions (CC& R' s) and all other T neighborhood and regulatory ag- ncy requirements. construction, which is deter ' nâ&#x20AC;˘ d by Desctes Co

owner agrees to remove any y not to meet standards. Date: / ./

Applicant' s Signature:

Check No./ Cash

Receipt No.

Amount Received:

Area Drawing Locating Subject Property A map can also be attached.)

Office Use Oniy

Approved Driveway Location:

Longitude:

Latitude:

Milepost:

Deschutes County Road Department Date:

Approved by Deschutes County Commu

Date:

Reviewed B

ry -

y Development Department

Jay

ermq

l, Zâ&#x20AC;&#x201D;` jr0

10/ 19/ 01

p 2 Q' O

APPROVALS:

YA:PTjF*: MASTER -

AX COLLECTOR

14WP0NMENTFNE."HEALTH DIRECTOR

COUNTY ROAD

DESCHUTES 011

DATE

G- 11- 15 9s

m..,.

DATE

M-

G. 13DATE

DATE

6 2Y_ 5

DATE

6- u

DATE

VALOREM TAXES AND SPECIAL. ASSESSMENTS,

I HEREBY CERTIFY THAT ALL TAXES ARE. PAID AS OF THIS DATE.

DESCHUTES 75101157455555477 I HEREBY CERTIFY THAT ALL. AD

FEES, AND OTHER CHARLES REQUIRED BY THE LAW TO BE PLACED ON THE

DATE

1997- 1998 TAX ROLLS WHICH BECAME A LIEN OR WILL BECOME A LIEN DURING THIS CALENDAR YEAR, HAVE BEEN PAID TO ME.

DESCI4ffiE5 COUNTY COMMISSIONER

PUBLIC.

FOUND ROD

PER " 4")

IRON

WIDE INGRESS - EGRESS

L- 12-- 1',.

20. 00 AC. NORTHWEST CORNER

LOT 14, WILD

648.34

HORSE MEADOWS FOUND 5/ 8" IRON 1700

DESCHUTES CO, DEED RECORDS,.

NET AREA =

PARCEL 1

CREATED THIS PARTITION)

EASEMENT

60'

SIGNATURE BY THE DESCHUTES COUNTY COMMISSIONERS CONSTITUTES ACCEPTANCE BY THE COUNTY OF ANY DEDICATION MADE HEREIN TO THE

27 1/ 28 34

L- 6

800K 84, PAGE 258,

POWER LINE EASEMENT, BOOK 25,

GEED RECORDS,

30'

DECLARATION:

9s KNOW ALL MEN BY THESE PRESENT THAT WE, LEWIS ANDERSON AND MARY ANDERSON. OWNERS THE

WIDE PUBLIC UTILITY

TO BE SURVEYED AND PARTITIONED INTO

IN FEE SIMPLE, AND DONALD C, JACOBSON AND BRENDA JACOBSON, BUYERS, OF THE LAND

54W/--DATE -..

1 c - z<' -?

DATE

T J / IC-•

6- 24- 9F

DATE

1DAY OF _.

1998,

EASEMENT TO THE PUBLIC, AND DO HEREBY SUBMIT FOR RECORD AND APPROVAL 5410 PLAT

PARCELS AND EASEMENTS A5 SHOWN, DO HERBY DEDICATE SAID 30'

SHOWN HEREON, HAVE CAUSED SAID LAND

BASIS OF N 84' 1

ADDITIONAL MONUMENTS WERE

84° 03' 47" E (

IRON ROD

PARTITION PLAT NO. lgg"3`

LAND PARTITION MP ®97- 31 1/

DESCHUTES COUNTY, OREGON

THE PARTITIONING OF A PARCEL OF LAND SITUATED 4 OF SEC. 26 AND THE N 1/ 2 OF SEC. 35, IN THE SE

T14S, R 10E, W. M., SURVEYOR' S CERTIFICATE:

NER OF AOT: TO, WILD HORSE MEADO

MAT', AS DECR40E13 ABOM: THd

887.9„5 FEET TO A 0":: i

AT THE NORTHWEST CORNER OE LOT: T=

1")

4")

2' W

211, 21537' 33' '.

80,39' (" 2")

4")

BCN,k

ma),

E 80

9,,

REGISTERED

2/ 3199

Jr:.

SURVEYOR

PROFESSIONAL

LAND

AST,

OREGON

MT '

1938

FREDERICKA.

RENEWAL

DESCHUTES CO,

TI4S, R10E, W, M,

WAY L7NE,: 256. 27 ETT,1 Y0 A 5. a ^ 8" MON RO0, THENCE N.

ORio CURVE 1T/. 1HE LETe, ( C810,RL:

N4.5' 48' 4J" W, 99-9

WILD NORSE MEADOW;

900

PER "

n44- Wq

INITIAL POINT ;

FOUND 5/ 8":

IRON ROD

WILD

PLAT OF WILD HORSE MEADOWS BY PLS 540 FILED JULY 7,

IRON PIPE

GT°

BOUNDARY LINE ADJUSTMENT LL - 95- 38 BY PLS 1938 FILED

1979,.

5510788

10,

23. 20 AC.

PARCEL 3

10,

790. 17'

PER " 4")

FOUND

HORSE MEADOWS

LOT

NORTHEAST CORNER

NET AREA =

5512335

SURVEY FOR B. CHAMOMILE BY PLS

1652 FILED MARCH

15,

1952..

A5 - BUILT SURVEY OF HINDMAN ( CAMP POLK) ROAD BY DESCHUTES CO. ROAD

1995,

OCTOBER

REFERENCES

3,.

5500076

DEPT.

LENGTH

3° 50' 21"

51° 55' 54"

DELTA

49.99'

653. 42'

CHORD

88° 32' 42" E

64° 25455" E ("

CH. BEARING

RADIUS

676. 34°

CURVE TABLE

CURVE

746 20'

49, 99'

5 54° 42' 21" E

746, 20'

3' 50' 21"

50,50. 00'00'

99191'

562..12'

5 43. 48' 43" E ("

60° 39' 34" E

746, 20'

10" 33' 29"

44° 15' 12"

00 05'

576,34'

5")

746 20'

541- 549- 7851

NT "

542::96'

11. 58 3/ 4'

542 96'

97759

2")

I, FRED A AST Jr., OREGON REGISTERED PROFESSIONAL LAND SURVEYOR NO, 1938, DO HEREBY CERTIFY THAT I HAVE CORRECTLY SURVEYED AND MARKED

WITH PROPER MONUMENTS THE LANDS REPRESENTED HEREON SITUATED IN THE SOUTHEAST QUARTER OF SECTION 26 AND THE NORTH HALF OF SECTION

THENCE 58.5'. 4. 1' 00" E, 50.00 T

Olt:Nor N31m4"196°°E, LEAVING' SAID Rt

SA/ 0 RIGHT 4 - 0E -WAY CINE N49. 08• 28°W, LEAM/ NC'42, 95 FOOT RALAlus fiLURVE TTA THE Tq1 7T, ( CHORD 9E TOA 5/ 8'" um RD0, ON 111E ARC OF A 746, 20 FOC

Try

600

61' 4I'(20" E, 1805. 00 FEET TOA 5// 8 71011 Roo ..00 P'

TOA 5/ 8" d71 74 Roo,

5%R"' KWON ROTI,

4050 091 LESS

J00

0. THE PO/ NT OE ffEC1NNWG

GRAPH/C SCALE -

S 89. 04°19" E 1888, 14' "

N 49° 05°28" W 1/

N 49° 05' 28°'W N 50° 15

189, 91'

258, 27' (" 2")

31. 64'

1 19. 00'

N 37°21' 36" 5 N 37° 21' 36" E

N 37. 21' 36" E

N 38' 16 3/ 4' W

N 38° 31' 57°W

DISTANCE

WILD HORSE MEADOWS

N 89° 08' 331W 1888° 01' "

N 89° 29' 55°°W 1887.93•

1097. 77' ('

THIS PARTITION)

30' WIDE INGRESS - EGRESS EASEMENT

CREATED

FOUND

IRON ROD

BEARING

LINE TABLE

L-

COURSE

L-

L- 34 6

L- 5 L-

68, 92°

2")

450, 00' (" 2") 434..74°

17° 59' 30" E 17° 55430" 5

419; 49°

71' 26' 19" E

519. 00' ("

N N

71. 26' 19" E

N 71° 26' 19" E

5 85° 43°00" E

515. 52'

L- 87

404. 44'

512. 24'

9 10 11

S 85° 43' 00" E

L-

N 84° 0347" E

85' 43' 00" E

L-

Oregon

L-

Sisters,

L-

11-

412'( 1, ON 144E E'AS"T DIVISION Or REt: ORR Silts 0. 52"58"'E, 702. 48 MI' 0 10005E MEADOWS ON..

35, TOWNSHIP 14 SOUTH, RANGE 10 EAST, WILLAMETTE MERIDIAN, DESCHUTES COUNTY, OREGON, AND THAT THE 5/ 8" IRON ROD FOUND AT THE NORTHEAST CORNER OF SAID SECTION 35 WAS ACCEPTED AS THE INITIAL POINT" FOR TH/ S LAND PARTITION " MP 97- 31", THE BOUNDARY OF WHICH 15

Box 751

300

MORE PARTICULARLY DESCRIBED AS FOLLOWS:

FEET°

30' ( TYPICAL)

W/L D HORSE MEADOWS

3001'

FOUND

56. 82 AC.

PARCEL 2 NET AREA =

WIDE PUBLIC THIS PLAT)

4")

5 00° 52' 47" E

UTILITY EASEMENT

30'

47" E 2527. 89'

BEARINGS:

GEODETIC CONTROL EXISTS WITHIN 0, 5 MILE OF THIS SITE

16/ 5. 54'

2476, 24' N 89" 09' 01"

1")

2476-36' "

N 89° 30' 18" W

S 69° 04' 19" F 2524..09' "

SET 5/ 6" X JO" / RON ROD WITH YELLOW PLASTIC CAP MARKED " F. AST PLS 1938".

P. 0.

FOUND 5/ 8" IRON ROD WITH YELLOW PLASTIC CAP MARKED " F. AST PL5 1938", UNLESS OTHERWISE DESCRIBED.. RECORD DATA AS PER REFERENCE MATERIAL

Cascade Avenue

LEGEND

5 89' 30' 18• E

250 W.

FEB

SET A5 INDICATED TO COMPLETE THE PARTITIONING OF SAID PARCEL.. NO UNUSUAL CONOTTION5 WERE ENCOUNTERED DURING THE COURSE OF THIS SURVEY.. NO KNOWN

THE DESCHUTES CO. ROAD DEPT., . 45 DEPICTED ON LL 95- 38,

NORTHEAST CORNER OF SECTION 35, A5 DEFINED ON 11 95- 38. ADDITIONAL MONUMENTS WERE FOUND AND HELD ALONG THE SOUTH LINE OF SAID PARCEL, SEE 0510786 AND CS00076 FOR ADDITIONAL INFORMATION, MONUMENTS WERE SET A5 INDICATED ON THE NORTHERLY RIGHT- OF- WAY LINE OF CAMP POLK ROAD BASED ON AN AS - BUILT SURVEY BY

MONUMENTS WERE FOUND ALONG THE NORTH BOUNDARY OF SAID PARCEL AND AT THE

LAND DESCRIBED AS PARCEL 0 ON BOUNDARY LINE ADJUSTMENT LL - 95- 38 ( C512335),

THE PURPOSE OF THIS SURVEY WAS TO DEFINE THE BOUNDARY OF THAT CERTAIN PARCEL OF

NARRATIVE:

NOTARY SIGNATURE

STATE OF OREGON

COUNTY OF DESCHUTES

THEREIN NAMED,

ANDERSON, AND DONALD C JACOBSON AND BRENDA JACOBSON, TO ME KNOWN TO BE THE INDIVIDUALS WHO EXECUTED THE FOREGOING °° DECLARATION°' AND ACKNOWLEDGED TO ME THAT THEY EXECUTED THE SAME FREELY AND VOLUNTARILY FOR THE PURPOSES

BEFORE ME, A NOTARY PUBLIC, PERSONALLY APPEARED LEWISANO RSON ANDAND MARY

THIS / 5 TO CERTIFY THAT ON THIS

ACKNOWLEDGMENTS:

BRENDA JACOBSON

LEWIS ANDERSON

OF MP - 97- 31,

473, PAGE 117, DESCHUTES CO, OFF/ CIAL RECORDS,.

PAGE 266, DESCHUTES CO,

TELEPHONE LINE RICHT- OF- WAY, 800K 363, PAGE 845, DESCHUTES CO,. DEED RECORDS,:

POWER LINE RIGHT- OF- WAY, BOOK 335, PAGE 912, DESCHUTES CO. DEED RECORDS,

WARRANTY DEED,

ADDITIONAL EASEMENTS

2, 3. 4

MEMORANDUM OF CONTRACT, BOOK

OFFICIAL RECORDS,.

INGRESS - EGRESS EASEMENT, BOOK 473, PAGE 125, DESCHUTES CO. OFFICIAL RECORDS,...

and Associates

45, DESCHUTES CO,

DEED RESTRICTIONS,

Jr.

BOOK 473, PACE /

Fred A.

GS 131e

NARRATIVE:

OREGON

STATE LAW,

BOUNDARY LINE ADJUSTMENT LL - 98- 53

30° WIDE INGRESS - EGRESS EASEMENT

0798ARCEL 2 OF

PARCEL 790

C22

FL' 18 V) .

PLS

1938".

1938",

3- 14.5 REGISTERED

1936

21.

AST.

In I

ORL GOB Jr

SURVEYOR

PROFESS IONAL LAND

74)

RENEWAL DATE 12/ 32/ 99

FREDERICK

FORMER

189403'

L-

N 7I° 26' 19" E

7° 59' 30" E

17° 59'. 30" E

N 3721' 36" E

61 37° 21' 36" E

N 37° 21° 36" E

450. 00'

31. 64°

119. 00'

189. 91'

5 85° 43' 00" E N 84° 0347E

5 85. 43' 00" E

512. 24' 404. 44°

515. 62'

OREGON

WILD

HORSE

1FROUNR0 O " ND50

DESCHUTES CO, OR

DELTA

653, 42'

CHORD

0 840)2°2112

S 88° 32' 42" E

S 64° 29' 55" E

26 125 3- 14s, R10E, W. M.

900

51° 55°54"

49, 99°

49. 99'

600

LENGTH

3° 50'21"

300

RADIUS

676, 34'

3° 50°21"

FEET

IRON PIPE -

79017'

St).- irr

CURVE

746. 20°

50, 00' 50. 00'

CI-LBEARING

746. 20°

549- 7051

746. 20°

541-

2 3

CURVE TABLE

GRAPHIC SCALE -

ONN

10,

FOUND

MEADOWS

LOT

NORTHEAST CORNER

DESCHUTES CO.,

L-

434, 74'

300

W/LD HORSE MEADOWS

N 8929°56" W

BOUNDARY LINE

1097 77'

LINE TABLE

L-

N 71. 26' 19" E

419, 49' 519, 00°

258. 27'

DISTANCE

L-

N 7126' 19.' E

BEARING

L-

5 85° 43' 00" E L-

66. 92°

L-

9 L-

Sisters, Oregon 97759

L-

L- 8

COURSE

2 OF SEC. 35, T14S, R10E, W. M.,

PARCEB L 499-

A PORTION OF PARCEL 2 AND ALL OF

I/ IRON ROD

FOUND

58. 93 AC,

06 647677) 079 PLA T

UNLESS OTHERWISE DESCRIBED.

P. O.

Box 751

895. 21'

NET AREA

PARCEL

1827. 90'

W/LD HORSE MEADOWS

N 89° 30' 18" W

21. 99 AC.

PACMTION PLAT 1998- 34„)

NET AREA =

30WIDE PUBLIC

UTILITY EASEMENT

MARKED ° T. AST -

SET 5/ 8" X 30" IRON ROD WITH YELLOW PLASTIC CAP

LEGEND O

PLS

FOUND 5/ 8" IRON ROD WITH YELLOW PLASTIC CAP MARKED " F. AST -

RECORD DATA AS PER REFERENCE MATERIAL

Cascade Avenue

139) (

4 OF SEC. 26 AND THE N 1/

BETWEEN PARCELS 2 AND 3 OF PARTITION PLAT NO. 1998- 34 SITUATED IN THE SE 1/

THE PURPOSE OF THIS SURVEY WAS TO ADJUST THE BOUNDARY BETWEEN PARCEL NO. 2 AND PARCEL NO, 3, PARTITION PLAT

NO UNUSUAL CONDITIONS WERE ENCOUNTERED DURING THE COURSE OF THIS SURVEY,

1998- 34, A PARTITION OF RECORD IN DESCHUTES COUNTY, OREGON, DAIS FIRM COMPLETED THE " PARTITION". ALL MONUMENTS SET OR FOUND DURING THE COURSE OF THE PARTITION WERE HELD, ADDITIONAL MONUMENTS WERE SET, AS INDICATED, TO

ADJUST THE BOUNDARIES, AS SHOWN.

SURVEYOR' S CERTIFICATE: I, FRED A, AST, Jr„ OREGON REGISTERED PROFESSIONAL LAND SURVEYOR NO. 1938, DO HEREBY CERTIFY THAT THIS SURVEY WAS

250 W.

vows essowro

WIDE INGRESS - EGRESS

EASEMENT

60'

PARCEL

PART/T/ON PLAT 1998- 34

otOrmlnm

1998- 34. ( C513326)

soodoromagrowooltrowoosf= 0

PERFORMED UNDER MY DIRECT SUPERVISION, AT THE REQUEST 079 0079 JACOBSON, DURING THE MONTH OF JULY, 1998 IN

ROD

4' CA40,

410" 4

dir414411L

L- 7-

IRON

FOUND

ACCORDANCE WITH

60, 414:./

cif6.

REFERENCE MATERIAL AND BASIS OF BEARINGS THE BASIS OF PARTITION PLAT NO,

ALL BEARINGS AND DISTANCES WERE TRANSCRIBED FROM OR CALCULATED ON

WARRANTY DEED, NOOK 84, PAGE 258, DESCHUTES CO, DEED RECORDS.

POWER LINE RIGHT- OF- WAY, BOOK 335, PACE 912, DESCHUTES CO, DEED RECORDS,

ADDITIONAL EASEMENTS

TELEPHONE LINE RIGHT- OF- WAY, BOOK 363, PAGE 845, DESCHUTES CO. DEED RECORDS

117, DESCHUTES CO. OFFICIAL RECORDS,

473, PAGE

POWER LINE EASEMENT, BOOK 28, PAGE 266, DESCHUTES CO, DEED RECORDS. MEMORANDUM OF CONTRACT, BOOK

4, 5,

7, DEED RESTRICTIONS, BOOK 473, PAGE 145, DESCHUTES CO, OFFICIAL RECORDS.

6, INGRESS - EGRESS EASEMENT, BOOK 473, PAGE 128, DESCHUTES CO, OFFICIAL RECORDS,

Fred A. Ast, Jr. and Associates

CS/ 3356

Ch d:

Roth

CS08721

SUBDIVISION PLAT OF " PANORAMIC

REFERENCE MATERIAL 1... PARTITION

F. AST –

FILED

and

1998.

1938'.

Associates

OF SEC.

36,

Jr,

SURVEYOR

1081

12/ 31/ 01

A,.. AST, 1938

DATE

Cascade

RENEWAL

FREDERICK

JULY 19,

OREGON

LAND

PROFESSIONAL

REGISTERED

AT" HTC. SCALE:

RECORDED AS 05( 3356..

est

T14S,

300

R 10E,

PARCEL A 33. 23 Acres

P. O.

600

Box

W. M.,

900

751

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LINE

798. 07°

ill T4M1

FOUND

LAW.

101

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1089. 86'

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1/ 2 OF SEC. COUNTY, OREGON

9 28'42' 16" E

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THE N

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Oregon

DURING THE COURSE OF THIS SURVEY.

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NARRATIVE:

STA TE

1, FRED A AST, JR„ OREGON REGISTERED PROFESSIONAL LAND SURVEYOR NO. 1938, DO HEREBY CERTIFY THAT THIS SURVEY WAS PERFORMED UNDER MY DIRECT SUPERVISION, AT T1- 10 REQUEST OF DON JACOBSON, DURING THE MONTHS OF OCTOBER AND NOVEMBER, 2001, IN ACCORDANCE WITH OREGON

SURVEYOR' S CERTIFICATE:

IRON

ADJUSTED:—,

DESCHUTES

26,

B0 UNDARY LINE ADJUSTMENT LL- 01-

1969..

OF LL - 98- 53,

2/ 1/

250

1 "--

ALL BEARINGS AND DISTANCES WERE TRANSCRIBED TROM OR CALCULATED ON THE BASIS

BASIS OF BEARINGS

THE NW

UNLESS OTHERWISE DESCRIBED.

0842 FILED

AND

BETWEEN PARCELS OF LAND SITUATED IN THE SE 1/ 4 OF SEC.

7/ 1/

VIEW ESTATESBY PLS FILED

1998.

1938

7/ 29/

PLS 1938'

Jr.

PLS

X . 30" IRON ROD WITH YELLOW PLASTIC CAP

Ast,

MARKED " FRED AST JR –

SET 5/ 8

MARKED

FOUND 5/ 8" IRON ROD WITH YELLOW PLASTIC CAP

1938

BY PLS

CS13326

LL - 98- 53 BY PLS

1998- 34

CSIJ356

Fred

LEGEND

S 3721° 36W 189. 91°

PLAT

N 3721' 36" E 258. 27

746.20'

Arc ..50.00"..f, CA 350' 27.`. 49. 99

N 51732' 42" W

CS14752

PANORAMIC ESTATES CC&RS FOR LEGAL LOT OF RECORD

WELL & IRRIGATION

Oregon Water Resources Department 725 Summer Street NE, Suite A Salem, Oregon 97301-1266 (503) 986-0900 www.wrd.state.or.us

CLAIM OF BENEFICIAL USE for Ground Water Permits claiming 0.1 cfs or less

A fee of $200 must accompany this form for permits with priority dates of July 9, 1987, or later. Claims received without the correct fee of $200 will be returned.

A separate form shall be completed for each permit. In cases where a permit has been amended through the permit amendment process, a separate claim for the permit amendment is not required. Incorporate the permit amendment into the claim for the permit. This form is subject to revision. Begin each new claim by checking for a new version of this form at: http://www.oregon.gov/owrd/pages/wr/cwre_info.aspx The completion of this form is required by OAR 690-014-0100(1) and 690-014-0110(4). Please type or print in dark ink. If this form is found to contain errors or omissions, it may be returned to you. Every item must have a response. If any requested information does not apply to the claim, insert “NA.” Do not delete or alter any section of this form unless directed by the form. The Department may require the submittal of additional information from any water user or authorized agent. “Section 8” of this form is intended to aid in the completion of this form and should not be submitted. If you have questions regarding the completion of this form, please call 503-986-0900 and ask for the Certificate Section. The Department has a program that allows it to enter into a voluntary agreement with an applicant for expedited services. Under such an agreement, the applicant pays the cost to hire additional staff that would not otherwise be available. This program means a certificate may be issued in about a month. For more information on this program see http://www.oregon.gov/owrd/pages/mgmt_reimbursement_authority.aspx

SECTION 1 GENERAL INFORMATION 1. File Information APPLICATION #

G-16448 COBU Version July 1, 2017

PERMIT # (IF APPLICABLE) PERMIT AMENDMENT # (IF APPLICABLE) G-16134 NA Page 1 of 10

2. Property Owner (current owner information) APPLICANT/BUSINESS NAME Jim Klemz ADDRESS 70015 Camp Polk Road CITY Sisters

PHONE NO. 541-549-1147 STATE OR

ZIP 97759

ADDITIONAL CONTACT NO.

E-MAIL jfklemz@gmail.com

If the current property owner is not the permit holder of record, it is recommended that an assignment be filed with the Department. Each permit holder of record must sign this form. 3. Permit holder of record (this may, or may not, be the current property owner) PERMIT HOLDER OF RECORD Current owner ADDRESS CITY

STATE

ZIP

ADDITIONAL PERMIT HOLDER OF RECORD NA ADDRESS CITY

STATE

4. Date of Site Inspection:

ZIP

June 19, 2019

5. Person(s) interviewed and description of their association with the project: NAME Jim Klemz 6. County:

DATE 6/19/2019

ASSOCIATION WITH THE PROJECT landowner

Deschutes

7. If any property described in the place of use of the permit final order is excluded from this report, identify the owner of record for that property (ORS 537.230(4)): OWNER OF RECORD NA ADDRESS CITY

STATE

ZIP

Add additional tables for owners of record as needed

COBU Version July 1, 2017

Page 2 of 10

SECTION 2 SIGNATURES CWRE Statement, Seal and Signature The facts contained in this Claim of Beneficial Use are true and correct to the best of my knowledge. Seal and Signature

CWRE NAME Michele Wright Sims ADDRESS 14865 Checkrein CITY Sisters

PHONE NO. 541-408-4777 STATE OR

ZIP 97759

ADDITIONAL CONTACT NO.

E-MAIL Sims.mw@gmail.com

Permit Holderâ&#x20AC;&#x2122;s of Record Signature or Acknowledgement Each permit holder of record must sign this form in the space provided below. The facts contained in this Claim of Beneficial Use are true and correct to the best of my knowledge. I request that the Department issue a water right certificate. SIGNATURE

COBU Version July 1, 2017

PRINT OR TYPE NAME

Page 3 of 10

TITLE

DATE

SECTION 3 CLAIM DESCRIPTION 1. Point(s) of Appropriation (POA): POA NAME OR NUMBER (CORRESPOND TO MAP) Well

WELL LOG ID # FOR ALL WORK PERFORMED ON THE WELL (IF APPLICABLE) DESC56863

WELL TAG # (IF APPLICABLE) L-75464

Attach each well log available for the well (include the log for the original well and any subsequent alterations, reconstructions, or deepenings) 2 Developed use(s), period of use, and rate for each use: POA USES IF IRRIGATION, NAME OR LIST CROP TYPE NUMBER Well

pasture

SEASON OR MONTHS WHEN WATER WAS USED 3/1 to 10/31

Total Quantity of Water Used

ACTUAL RATE OR VOLUME USED (CFS, GPM, OR AF) 0.115 cfs

0.115 cfs

3. Provide a general narrative description of the distribution works. This description must trace the water system from each point of appropriation to the place of use: Water is pumped from the well into the pond, then in to the distribution system. Reminder: The map associated with this claim must identify the location of the point(s) of diversion, Donation Land Claims (DLC), Government Lots (GLot), and Quarter-Quarters (QQ).

4. Variations: Was the use developed differently from what was authorized by the permit, permit amendment final order, or extension final order? If yes, describe below.

YES

(e.g. “The permit allowed three points of diversion. The water user only developed one of the points.” or “The permit allowed 40.0 acres of irrigation. The water user only developed 10.0 acres.”)

The user was allowed to develop 10.0 acres, but only developed 9.2 acres. The footprint of the water is different than shown on the application map. 5. Claim Summary: POD / POA MAXIMUM NAME OR # RATE AUTHORIZED

Well

0.125 cfs

COBU Version July 1, 2017

CALCULATED

AMOUNT OF

THEORETICAL RATE BASED ON SYSTEM

WATER MEASURED

0.169 cfs

USE

Page 4 of 10

# OF

# OF ACRES

ACRES ALLOWED

DEVELOPED

10.0

9.2

SECTION 4 SYSTEM DESCRIPTION Are there multiple POAs?

If “YES” you will need to copy and complete Sections 4B through 4F for each POA. POA Name or Number this section describes (only needed if there is more than one):

Well A. Place of Use Attach Claim of Beneficial Use map. Reminder: The map associated with this claim must identify Donation Land Claims (DLC), Government Lots (Gov Lot), Quarter-Quarters (QQ), and if for irrigation, the number of acres irrigated within each projected DLC, Gov Lot, and QQ.

B. Appropriation and Delivery System Information Provide the following information concerning the appropriation and delivery system. Information provided must describe the equipment used to transport and apply the water from the point of appropriation to the place of use. 1. Is a pump used? 2. Pump Information (Well) MANUFACTURER Grundfos

YES

MODEL

SERIAL NUMBER

TYPE (CENTRIFUGAL, TURBINE OR SUBMERSIBLE) Submersible

40S-150-44DS

3. Theoretical Pump Capacity HORSEPOWER OPERATING PSI

LIFT FROM SOURCE TO PUMP *IF A WELL, THE WATER LEVEL

LIFT FROM PUMP TO PLACE OF USE

DURING PUMPING

15 hp

50 psi

496’

flat

TOTAL PUMP OUTPUT (IN CFS) 0.169 cfs

4. Provide pump calculations: Q = (15hp)(7.04) = 0.169 cfs 496’+127’ 5. Measured Pump Capacity (using meter if meter was present and system was operating) INITIAL METER ENDING METER DURATION OF TIME TOTAL PUMP OUTPUT READING READING OBSERVED (IN CFS) NA Reminder: For pump calculations use the reference information at the end of this document.

COBU Version July 1, 2017

Page 5 of 10

2. Pump Information (Pond) MANUFACTURER Berkeley

MODEL

SERIAL NUMBER s40097

LTH- 5

3. Theoretical Pump Capacity HORSEPOWER OPERATING PSI

LIFT FROM SOURCE TO PUMP *IF A WELL, THE WATER LEVEL

TYPE (CENTRIFUGAL, TURBINE OR SUBMERSIBLE) centrifugal LIFT FROM PUMP TO PLACE OF USE

DURING PUMPING

5hp

90 psi

3’

flat

TOTAL PUMP OUTPUT (IN CFS) 0.143 cfs

4. Provide pump calculations: Q = (5hp)(6.61) = 0.143 cfs 3’+228.6’ 5. Measured Pump Capacity (using meter if meter was present and system was operating) INITIAL METER ENDING METER DURATION OF TIME TOTAL PUMP OUTPUT READING READING OBSERVED (IN CFS) NA Reminder: For pump calculations use the reference information at the end of this document.

6. Sprinkler Information SIZE OPERATING SPRINKLER PSI OUTPUT (GPM) Hunter 90 3.5 gpm I25 5/32” 90 6.9 gpm gun 90 40 gpm

TOTAL

MAXIMUM NUMBER USED

TOTAL SPRINKLER OUTPUT (CFS)

NUMBER OF SPRINKLERS 172

1.34 cfs

64 1

8 1

0.98 cfs 0.09 cfs

Reminder: For sprinkler output determination use the reference information at the end of this document.

7. Additional notes or comments related to the system: Pop-ups irrigate most of pasture, but hand lines and a gun are used to fill in areas not covered by pop-ups.

C. Groundwater Source Information (Well and Sump) 1. Describe the access port (type and location) or other means to measure the water level in the well: Top of well

COBU Version July 1, 2017

Page 6 of 10

2. If well logs are not available, provide as much of the following information as possible: CASING CASING TOTAL COMPLETION COMPLETION WHO THE WELL DIAMETER DEPTH DEPTH DATE OF DATES OF WAS DRILLED ORIGINAL ALTERATIONS FOR WELL See log

WELL DRILLED BY

3. In addition to the information requested in item “2” above, provide any other information which may help the Department locate any well logs associated with this appropriation. DESC56863 4. Is the appropriation from a dug well (sump)?

D. Storage 1. Does the distribution system include in-system storage (i.e. storage tank, bulge in system / reservoir)

YES

If “YES” is it a:

Storage Tank Bulge in System / Reservoir YESComplete appropriate table(s), unused table may be deleted.

2. Storage Tank: MATERIAL (CONCRETE, FIBERGLASS, METAL, ETC.)

CAPACITY (IN GALLONS)

ABOVE GROUND OR BURIED

NA 3. Bulge in System / Reservoir: RESERVOIR NAME OR NUMBER (CORRESPOND TO MAP) Pond

APPROXIMATE DAM HEIGHT NA (excavated)

APPROXIMATE CAPACITY (IN ACRE FEET) 0.05

E. Gravity Flow Pipe (THE DEPARTMENT TYPICALLY USES THE HAZEN-WILLIAM’S FORMULA FOR A GRAVITY FLOW PIPE SYSTEM)

1. Does the system involve a gravity flow pipe?

F. Gravity Flow Canal or Ditch (THE DEPARTMENT TYPICALLY USES MANNING’S FORMULA FOR CANALS AND DITCHES)

1. Provide description and calculations if necessary: NA

COBU Version July 1, 2017

Page 7 of 10

SECTION 5 CONDITIONS All conditions contained in the permit, permit amendment, or any extension final order shall be addressed. Reports that do not address all performance related conditions will be returned. 1. Time Limits: Permits and any extension final orders contain any or all of the following dates: the date when the actual construction work was to begin, the date when the construction was to be completed, and the date when the complete application of water to the proposed use was to be completed. These dates may be referred to as ABC dates. Describe how the water user has complied with each of the development timelines established in the permit or extension final order: DATE FROM DATE DESCRIPTION OF ACTIONS TAKEN BY PERMIT ACCOMPLISHED* WATER USER TO COMPLY WITH THE TIME LIMITS ISSUANCE DATE 12/14/2006 BEGIN NA CONSTRUCTION (A) COMPLETE 10/1/2011 Applied for extension 3/15/2013 CONSTRUCTION (B) Issued 7/30/2013 COMPLETE 10/1/2011 6/19/2019 Meter installed, mitigation credits APPLICATION OF 10/1/2022 purchased, water applied, use WATER (C) reported * MUST BE WITHIN PERIOD BETWEEN PERMIT OR ANY EXTENSION FINAL ORDER ISSUANCE AND THE DATE TO COMPLETELY APPLY WATER

2. Is there an extension final order(s)?

YES

3. Initial Water Level Measurements: a. Was the water user required to submit an initial static water level measurement?

4. Annual Static Water Level Measurements: a. Was the water user required to submit annual static water level measurements?

5. Pump Test (Required for most ground water permits prior to issuance of a certificate) a. Did the permit require the submittal of a pump test?

YES

b. Has the pump test been previously submitted to the Department?

c. Is the pump test attached to this claim?

YES

d. Has the pump test been approved by the Department?

e. Has a pump test exemption been approved by the Department?

YES

NO NO

**The Claim will not be reviewed until a pump test or exemption has been approved by the Department.

6. Measurement Conditions: a. Does the permit, permit amendment, or any extension final order require the installation of a meter or approved measuring device? YES Reminder: If a meter or approved measuring device was required, the COBU map must indicate the location of the device in relation to the point of appropriation. COBU Version July 1, 2017

Page 8 of 10

b. Has a meter been installed?

YES

c. Meter Information POA NAME OR # Well

MANUFACTURER

SERIAL #

CONDITION (WORKING OR NOT)

CURRENT METER READING

DATE INSTALLED

7. Recording and reporting conditions a. Is the water user required to report the water use to the Department?

YES

b. Have the reports been submitted? METHOD OF SUBMITTING REPORT (PAPER OR ELECTRONIC) Electronic

YES WATER USER REPORTING ID 62407

If the reports have not been submitted, attach a copy of the reports if available. 8. Other conditions required by permit, permit amendment final order, or extension final order a. Were there special well construction standards?

b. Was submittal of a ground water monitoring plan required?

c. Other conditions?

YES

If “YES” to any of the above, identify the condition and describe the water user’s actions to comply with the condition(s): Water user required to purchase 18.0 mitigation credits in the General Zone. 9.0 temporary credits were purchased from MP-44; 7.11 permanent credits were purchased from MP-27; 1.89 permanent credits purchased from MP-25.

SECTION 6 ATTACHMENTS Provide a list of any additional documents you are attaching to this report: ATTACHMENT NAME Well log

DESCRIPTION DESC56863

SECTION 7 CLAIM OF BENEFICIAL USE MAP The Claim of Beneficial Use Map must be submitted with this claim. Claims submitted without the Claim of Beneficial Use map will be returned. The map shall be submitted on poly film at a scale of 1” = 1320 feet, 1” = 400 feet, or the original full-size scale of the county assessor map for the location. COBU Version July 1, 2017

Page 9 of 10

Provide a general description of the survey method used to prepare the map. Examples of possible methods include, but are not limited to, a traverse survey, GPS, or the use of aerial photos. If the basis of the survey is an aerial photo, provide the source, date, series and the aerial photo identification number. Irrigation areas mapped using a Bad Elf Surveyor GPS unit. Additional mapping based on aerial photos (GoogleEarth images dated 7/27/2018)

Map Checklist Please be sure that the map you submit includes ALL the items listed below. (Reminder: Incomplete maps and/or claims may be returned.)

Map on polyester film. Appropriate scale (1” = 400 feet, 1” = 1320 feet, or the original full-size scale of the county assessor map) Township, Range, Section, Donation Land Claims, and Government Lots If irrigation, number of acres irrigated within each projected Donation Land Claims, Government Lots, Quarter-Quarters Locations of meters and/or measuring devices in relationship to point of diversion or appropriation. Conveyance structures illustrated (pumps, reservoirs, pipelines, ditches, etc.) Point(s) of diversion or appropriation (illustrated and coordinates) Tax lot boundaries and numbers NA Source illustrated if surface water Disclaimer (“This map is not intended to provide legal dimensions or locations of property ownership lines”) Application and permit number or transfer number North arrow Legend CWRE stamp and signature

COBU Version July 1, 2017

Page 10 of 10

PUMP TEST UNREASONABLE BURDEN EXEMPTION REQUEST FORM

OWNER NAME/BUSINESS NAME

PHONE NO.

ADDITIONAL CONTACT NO.

ADDRESS CITY

STATE

ZIP

E-MAIL

If there is a reason why a pump test cannot be performed on a well, or a reason why a pump test cannot meet all of the specifications outlined in OAR 690-217-0005 to 690-217-0055, the owner may request from the Director an exemption from the pump test requirement. Requests shall be in writing and include the reason why a pump test cannot be performed or meet the full specifications. Exemptions, or conditioned exemptions, shall be granted if the reasons are found to be valid and eliminating the problem or meeting the full specifications would place an unreasonable burden on the well owner. Exemptions shall be granted for public water supply wells if pump testing will cause interruption of service to customers. OAR 690-217-0015(3) and (4).

1. List each well and associated water right(s) for which you are requesting an exemption. If a well is listed on more than one water right, be sure to include them all here. If additional space is needed, please attach another form. If available, please attach all water well reports (i.e. well logs) and a map showing the locations of all wells listed on this form. WELL LOG #

WELL TAG #

(EX. MARI 99999)

(EX. L-999999)

a b c d e

OWNER W ELL NAME OR #

LLLLL-

APPLICATION

PERMIT

TRANSFER

GGGGG-

TTTTT-

(CONTINUED) 3B

TWP

(EX: 25S)

RNG

(EX: 31E)

SEC

(EX: 12)

(EX: SE/SW)

10B

SURVEYED LOCATION

11B

(Ex: 100 ft N & 735 ft E fr SE cor, sec 5)

12B

LATITUDE

13B

(EX: 44.94473859)

14B

LONGITUDE

15B

(EX: -123.02787000)

16B

a b c d e 2. Please explain why the test cannot be performed or meet the required pump test program specifications:

I hereby certify that the well(s) requested for exemption(s) are under my ownership.

SIGNATURE:

DATE Page 1 of 1

OWRD 20181004

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