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Home My WebLink About4G - North Shore Oaks First Addition STAFF AGENDA REPORT MEETING DATE: AGENDA #: PREPARED BY: AGENDA ITEM: NOVEMBER 15, 1999 4G RALPH TESCHNER, FINANCE DIRECTOR CONSIDER APPROVAL OF RESOLUTION 99-;xX AUTHORIZING SPECIAL ASSESSMENT DEFERRAL FOR CITY PROJECT 99-13 NORTH SHORE OAKS 1 ST ADDITION SEWER & WATER INST ALLA nON I~'L DISCUSSION: Introduction The purpose of this agenda item is to consider approval of the deferment application for special assessments on PIN# 25 066 006 0 owned by Juanita Jones in the amount of$11,193.02. History At its regular meeting of October 4, 1999 the City Council adopted the assessment roll for Project 99-13 North Shore Oaks 1st Addition sewer and water improvements. On November 2, 1999 Juanita Jones submitted an application for deferment of her special assessment. Current Circumstances Prior Lake City Code, Section 111 allows for the deferment of assessment principal and interest of the following four criteria are satisfied: 1. Applicant must be 65 years of age or older. 2. The qualifying property must be the homestead of the applicant. 3. Annual gross income shall not exceed the income limits as set forth by family size according to Attachment A of Ordinance 86-3. (1999 income limitation for an individual is $24,269.00) 4. Total special assessment to be deferred must exceed $1000.00. The application for the deferment of special assessments for this parcel is complete and the applicant meets all City requirements. Also, the principal amount continues to accrue interest on the unpaid balance while deferred. 16200 Eagle Creek Ave. S.E., Prior Lake, Minnesota 55372-1714 / Ph, (612) 447-4230 / Fax (612) 447-4245 AN EQUAL OPPORTUNITY EMPLOYER H:IASSESSIAGDEFER.DOC AL TERNA TlVES: RECOMMENDED MOTION: REVIEWED BY: Attachments: 1. A motion as part of the consent agenda to approve Resolution 99-XX authorizing special assessment deferment for the application submitted. 2. Remove from the consent agenda and reject the Resolution for a specific reason, Alternative #1 - a motion as part of the consent agenda to approve the Resolution and appl' tion for deferment as submitted. H: IASSESSIDEFERAP. DOC APPLICATION FOR DEFERMENT OF SPECIAL ASSESSMENTS Pursuant to City of Prior Lake Code 1-13-1 ': '~":~~f!!-05 TO: City Manager City of Prior Lake I, Juanita Jones the undersigned declare under penalties of perjury: That I reside at 5375 140th St NE That my spouse is (name) That I am 65 years or older and that my date of birth is 1/10/23 That my family size/number of dependents is 1 IF APPLICABLE: That I am retired by reason of permanent and total disability (Please attach a sworn affidavit by a licensed medical doctor to the fact that you are unable to be gainfully employed due to a permanent and total disability). That the following described property is owned by and is the homestead of the applicant: Property Address 5375 140th St. NE Phone Number 445-8365 Legal Description Lot 6 North Shore Oaks 1 st Addition Parcel Identification Number 25 066 006 0 That my annual gross income for myself and my spouse as reported on applicant's most recent income tax return (attach a copy of your last year's Federal Income Tax Return), plus non - taxable income received such as Social Security, pension, worker's compensation or similar proceeds is $ .' 1 if 15: which does not exceed the family size income limits according to Attachment A of Ordinance 86-03. Applicant hereby requests that the following special assessment of $11.193.02 for Project 99-13 which is levied against the above described property be deferred. I hereby acknowledge that any of the following reasons shall result in the total amount of the deferred special assessment, including interest, to be certified currently upon the property tax rolls of Scott County to be collected over the appropriate time period. 1. Failure to renew this application each year by September 30th. 2. Death of the owner, if the spouse is not eligible for benefits. 3. Sale, transfer or subdivision of the property or any part thereof. 4. Loss of homestead status. 5. Determination of no hardship. Form 1040A Label ; Department of the Treasury-Intemal Revenue Service I U.S. Individual Income Tax Return ceJ FI/ (s) 1998 IRS Use Only-Do not write or staple in this space. OMS No. 1545-00B5 Use the IRS label. Otherwise, please print or type. Filing status Check only one box. Exemptions .~ If more than seven dependents, see page 21. (See page lB.) r Income Attach Copy B of your Forms W-2 and 1099-R here. If you did not get a W-2, see page 24. Enclose, but do not staple, eny payment. Adjusted gross income Your social security number '~ Spouse's social security number ZY JUANITA M 5375 140TH PRIOR LAKE I R S \pI. no, S09 76 JONES ST NE NN 55372-1212 .. IMPORTANT!'" You must enter your SSN(s) above. Presidential Election Campaign Fund (See page 19.) Do you want $3 to go to this fund? . . . . . . . . If a joint turn, does your spouse want $3 to go to this fund? 1 Single 2 0 Married filing joint return (even if only one had income) 3 0 Married filing separate return. Enter spouse's social security number above and full name here. ~ 4 0 Head of household (with qualifying person). (See page 20.) If the qualifying person is a child but not your dependent, enter this child's name here. ~ 5 0 ualifying widow(er) with dependent child (year spouse died ~ 19 6a Yourself. II your parent (or someone else) can claim you as a dependent on his or her tax return, do not check box 6a. Yes No Note: Checking "Yes" will not change your tax or reduce our refund. bD Spouse C Dependents: (2) Dependent's social (3) Dependent's (4!yif qualified relationship to child for child - security number tax credit (see (1) First name Last name you paQe 22) 0 : : 0 0 : : 0 . 0 : : 0 0 d Total number of exem tions claimed. 7 Wa es salaries ti s etc. Attach Form s W-2. 8a Taxable interest. Attach Schedule 1 if re uired. b Tax-exempt interest. DO NOT include on line 8a. 8b 9 Ordina dividends. Attach Schedule 1 if re uired. 10a Total IRA 10b distributions. 10a .11a Total pensions 11b and annuities. 11 a 'T~ t:, C) 0 i 12 Unem 10 ment compensation. : 13a Social security 13b , benefits. 13a 10b 11 b 12 13b f14 Add lines 7. through 13b (far right column). This is your total income. ~ 14 ; 15 IRA deduction (see pa e 28). 15 >16 Student loan interest deduction see a e 28 . 16 ; 17 Add lines 15 and 16. These are our total adjustments. 17 ~ 18 Subtract line 17 from line 14. This is your adjusted gross income. ~ If under $30,095 (under $10,030 if a child did not live with you), see the EIC instructions on page 36. ~ 18 r f For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 49. Cal. No. 11327A ). (See page 21.) 1 No. ot boxes checked on 6a and 6b No. ot your ' children on 6c who: . lived with you . did not live with you due to divorce or separation (see page 23) Dependents on 6c not entered above Add numbers IT] entered on lines above 7 8a 9 5' 7J.. 1998 Form 1040A