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HomeMy WebLinkAboutCC 8 16 16_WA abatement form WASHINGTON COUNTY ASSESSMENT DIVISION APPLICATION FOR ABATEMENT-GENERAL FORM (M.S.)375.192 CLASSIFICATION/DISASTER CREDIT/SPECIAL ASSESSMENTS Worksheet#: Assessment Year: 2015 Payable Year: 2016 APPLICANT Owner's Name (please print or type) Soc.Sec./Fed ID Phone Cell Tax Forfeit Land-State of MN Owner's Name Soc.Sec./Fed ID Phone Cell Owner's Name Soc.Sec./Fed ID Phone Cell Owner's Mailing Address Property Address(if different from mailing address) 500 Lafayette Road City State Zip City State Zip St. Paul MN 55155 DESCRIPTION OF PROPERTY Property ID Number MP Number 01.029.21.11.0008 Legal Description of Property City or Township School District# TAG Lake Elmo 834 ASSESSOR'S ESTIMATED MARKET VALUE Original: Land EMV Improvement EMV Total Classification Revised: Land EMV Improvement EMV Total Classification Applicant's Statement of Facts: The City of Lake Elmo assessed this parcel for unpaid utility bills. This parcel was in a tax forfeit status and the transaction should not have been processed and needs to be abated. Applicant's Request: Abate the special assessment amount of$140.50 for Pay 2016. A licant's Signature: Date: Note: Minnesota Statute's 1988,Section 609.41,"Whoever,in making any statement,oral or written,which is required or authorized by law to be made as a basis of imposing,reducing,or abating any tax or assessment,intentionally makes any statement as to any material matter which the maker of the statement knows is false may be sentenced,unless otherwise provided by law,to imprisonment for not more than one year or to payment of a fine of not more than$3,000.00 or both. Note: Must include City/Township Resolution for reductions on assessments Note: Must include Fire report for Local Option Disaster Credit 1 Rev 5/10 OFFICE USE ONLY Market Value Tax and Other Special Class Land Improvement Total Tax Capacity Other Credits Asmts Total Payable Original LNTC Line 1 TIF Line 2 FD Line 3 STATE Line 4 RMV Line 5 PWR LN CR Total AG CR HMST CR TOTAL Market Value Tax and Other Special Class Land Improvement Total Tax Capacity Other Credits Asmts Total Payable Proposed LNTC Line 1 TIF Line 2 FD Line 3 STATE Line 4 RMV Line 5 PWR LN CR Total AG CR HMST CR TOTAL TOTAL REDUCTION REPORT OF INVESTIGATION ❑ Tax is paid as of: Local Tax Rate: ❑ Tax NOT paid as of: RMV Rate: After examining the applicant's claims,I have carefully_investi�ated this apRlication and find the facts to be as follows: Investigator's Signature Date CERTIFICATE OF APPROVAL—COUNTY ASSESSOR Note:(tinder$10,000)For this abatement to be approved,the Assessor and Director of Property Records and Taxpayer Services must boll:favorably recommend its adoption. ASSESSOR'S RECOMMENDATION (County Assessor or City Assessor) CRITERIA: Approved Denied Assessor's Signature Date DIRECTOR'S RECOMMENDATION Approved Denied Director's Signature Date ❑ ❑ COUNTY BOARD OF COMMISSIONER'S—COUNTY AUDITOR Note:For abatements resulting in a change of$10,000 and above including tax,penalty and interest.For this abatement to be approved,the Assessor,Director of Property Records and Taxpayer Services,and the County Board of Commissioners must all favorably recommend its adoption. Approved Denied Auditor's Signature Date I certify that at a meeting held(month,day) (year) the County Board of Commissioners took the above action on this abatement. This action was duly adopted and entered upon the minutes of its proceedings as a public record,showing the names of taxpayers,other concerned persons and the amounts involved. 2 Rev 5/10