FORM 122
REPORT OF ASSESSMENT FOR OMITTED OR
Assessment year
UNDERVALUED PROPERTY ASSESSMENT
March 1, 20 ______
AND ASSESSMENT PENALTIES
State Form 9283 (R3 / 10-01)
You are hereby notified that the undersigned has assessed the taxpayer mentioned below for omitted or undervalued property as follows:
Name of taxpayer
For year of
Address (number and street or Rural Route, city, state, ZIP code)
Taxing district
Township
County
Original personal property return filed
Date return was due
________________________________, 20 ______
________________________________, 20 ______
ORIG. ASSESSMENT
ADDED ASSESSMENT
TOTAL ASSESSMENT
PERSONAL PROPERTY
0.00
$ _________________
$ _________________
$ _________________
LAND
REAL ESTATE
0.00
$ _________________
$ _________________
$ _________________
IMPROVEMENTS
0.00
$ _________________
$ _________________
$ _________________
TOTAL
0.00
0.00
0.00
$ _________________
$ _________________
$ _________________
Description of Real Estate
IN ADDITION TO THE ADDED ASSESSMENT(S) SHOWN ABOVE, THE FOLLOWING PENALTIES ARE TO BE ADDED.
The county auditor shall add the penalty(s) to the property tax installment next due for the return.
PENALTIES
20% of Tax on
Undervalued
20%
Personal
25.00
$25.00
of Tax
Property
(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 (6-1.1-37-7(e))
TOTAL PENALTIES
$0.00
$25.00
$0.00
TO BE ADDED
A penalty is due with an installment under (a), (b), (c), or (d) whether or not an appeal is filed under IC 6-1.1-15-5 with respect to the tax due on that installment.
Signature of official
Title
Date
ORIGINAL - County Auditor; DUPLICATE - Assessing Official
1
