Free 22691.FH11 - Indiana

Reset Form

REPORT TO COUNTY AUDITOR OF ADDED ASSESSMENTS AND ASSESSMENT PENALTIES
State Form 22691 (R3 / 9-08) Prescribed by the Department of Local Government Finance

FORM 122A

Page of

INSTRUCTIONS:

1. If the penalty is for (a) or (b) below, indicate the penalty being applied in the left hand column and place the appropriate dollar amount in the space provided. 2. If the penalty is for (c) or (d) below, indicate ONLY the assessed value subject to the penalty in the appropriate column above. 3. Where the assessor has granted an extension of time for filing the personal property tax return, the penalty imposed under (c) below does not apply until 30 days after the expiration of such extension. 4. A penalty is due with an installment under (a), (b), (c) or (d) below whether or not an appeal is filed under IC 6-1.1-15-5 with respect to the tax due on that installment. 5. The purpose of this form is to be an internal transmittal from the assessing official to the county auditor. TO THE COUNTY AUDITOR You are hereby notified that the following list of taxpayers have received added assessments or have penalties to be added to their assessments for one (1) or more of the following reasons: a. Fails to include on a personal property return the information that the Department of Local Government Finance requires 6-1.1-37-7(d); 6-1.1-3-9; 6-1.1-5-13. b. Fails to file a required personal property return on or before the due date. 6-1.1-37-7(a) c. Fails to file the personal property return within thirty (30) days after the due date. 6-1.1-37-7(a) d. Undervalues the property that he reports on a personal property return and if the amount by which the person undervalues that property exceeds five percent (5%) of the value which should have been reported on that return, then the county auditor shall add a penalty of twenty percent (20%) of the additional taxes finally determined to be due as a result of the undervaluation. 6-1.1-7(f) NOTE: County Auditor shall add penalties provided in IC 6-1.1-37-7.
Township Tax district

County

NAME AND ADDRESS OF TAXPAYER (1)

ASSESSMENT ADDED TOTAL YEAR ASSESSMENT ASSESSMENT Indicate (a) or (b) in left (2) (3) (4) hand column $25.00

PENALTIES FROM INSTRUCTIONS ABOVE d a or b c
No return filed within 30 days of due date 20% of Tax 20% of tax undervalued personal property

ASSESSED VALUE SUBJECT TO PENALTY

Signature of Assessing Official

Title

Date signed (month, day, year)