Fillable CLAIM FOR REAL PROPERTY TAX DEDUCTION ON DWELLING (City Connections)

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CLAIM FOR REAL PROPERTY TAX DEDUCTION ON DWELLING (City Connections)

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Property Administration
Form PTD rev. 10/2019 Page 1 of 4
CLAIM FOR REAL PROPERTY TAX DEDUCTION ON DWELLING HOUSE OF QUALIFIED NEW JERSEY
RESIDENT SENIOR CITIZEN, DISABLED PERSON, OR SURVIVING SPOUSE/SURVIVING CIVIL UNION
PARTNER
(N.J.S.A. 54:4-8.40 et seq.; L.1963 c.172 as amended) (N.J.A.C. 18:14-1.1 et seq.); Civil Union Act PL 2006, c.103, effective 2/19/07
IMPORTANT: File this completed claim with your municipal tax assessor or collector. (See instructions on reverse.)
1. CLAIMANT NAME
_______________________________________________________________________________________________________
Name(s) of claimant owner(s) permanently residing in dwelling house.
2. DWELLING LOCATION
_______________________________________________________________________________________________________
Street Address of resident owner claimant's dwelling. (Unit # if Co-op)
_______________________________________________________________________________________________________
County & Municipality Claimant Phone Number
_______________________________________________________________________________________________________
Block / Lot / Qualifier Claimant Email
3. YEAR OF DEDUCTION This deduction is claimed for the tax year________________ (indicate tax year).
4. CITIZEN & RESIDENT (Complete A & B)
A. I was a citizen of New Jersey as of October 1 of the pretax year, i.e., the year prior to the tax year for which
deduction is claimed; and
B. I was also a legal or domiciliary resident of New Jersey for at least one year immediately prior to October 1 pretax
year. See instructions 2 & 3.
5. OWNER & OCCUPANT
I (my spouse/civil union partner and I, as tenants by entirety), solely owned, held title to above identified dwelling occupied
as my (our) principal or permanent residence as of October 1 of the pretax year. See instructions 4 & 5.
**Complete 5a only if partial owners
_______________________________________________________________________________________________________
5a. Name of part owner % ownership interest in property
**Complete 5b only if resident-tenant shareholder in Cooperative or Mutual Housing Corporation
_______________________________________________________________________________________________________
5b. Corporation Name of Cooperative or Mutual Housing
_______________________________________________________________________________________________________
Co-op/M.H. Corp. Street Address Municipality State
$_____________________________ Co-op
Net Property Tax Amount for Unit Mutual Housing Corp.
Property Administration
Form PTD rev. 10/2019 Page 2 of 4
6. ANNUAL INCOME LIMIT (must be reaffirmed by March 1 following year for which deduction was given.)
During the tax year for which the deduction is claimed, I reasonably anticipate that my annual income (and that of my
spouse/civil union partner combined) will not exceed $10,000 after a permitted exclusion of Social Security Benefits, or
Federal Government Retirement/Disability Pension, or State, County, Municipal Government and their political subdivisions
and agencies Retirement/Disability Pension. See instructions 6 & 8.
7. BIRTH DATE - MARITAL/CIVIL UNION STATUS
A. Date of Birth_________________________________________________________
B. Single Married/Civil Union Partner Surviving Spouse/Surviving Civil Union Partner
Legally Separated/Divorced/Dissolutioned
8. SENIOR OR DISABLED CITIZEN OR SURVIVING SPOUSE/SURVIVING CIVIL UNION PARTNER
(Choose A, B, or C)
A. I was age 65 or more years as of December 31, of the year prior to tax year for which deduction is claimed.
B. I was permanently and totally disabled and unable to be gainfully employed as of December 31 of the year prior
to the tax year. ATTACH PHYSICIAN'S OR SOCIAL SECURITY DISABILITY OR NEW JERSEY COMMISSION
FOR BLIND CERTIFICATE.
C. I was a surviving spouse/surviving civil union partner as of October 1 of the year prior to the tax year and have
not remarried/entered into a new civil union partnership.
I was age 55 or more as of December 31 of the year prior to the tax year and at time of my spouse's/civil union
partner’s death.
**My deceased spouse/civil union partner at his or her death was receiving a
senior citizen's property tax deduction or a
permanently and totally disabled person's property tax deduction.
9. REAL PROPERTY TAX DEDUCTION OTHER DWELLING
I (and my spouse/civil union partner) did not receive a senior or disabled citizen or surviving spouse/civil union partner (if
applicable) property tax deduction on another dwelling for the same tax year except on my (our) former home identified below
where I (we) resided from ________________month/year to _________________month/year.
_______________________________________________________________________________________________________
Street Address Municipality
I certify the above declarations are true to the best of my knowledge and belief and understand they will be considered as if
made under oath and subject to penalties for perjury if falsified.
_______________________________________________________________________________________________________
Signature of Claimant Date
OFFICIAL USE ONLY
Block____________________ Lot__________________ Approved in amount of $________________
Age Disability Surviving Spouse/Surviving Civil Union Partner of senior citizen or disabled person
Assessor_______________________________________________________________Date___________________
Collector_______________________________________________________________Date___________________
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Property Administration
Form PTD rev. 10/2019 Page 3 of 4
GENERAL INSTRUCTIONS
1. APPLICATION FILING PERIOD - File this form with the municipal tax assessor from October 1 through
December 31 of the pretax year, i.e., the year prior to the calendar tax year or with the municipal tax collector
from January 1 through December 31 of the calendar tax year. For example, for a property tax deduction claimed
for calendar tax year 2019, the pretax year filing period would be October 1 - December 31, 2018 with the
assessor and the tax year filing period would be January 1 - December 31, 2019 with the collector.
2. ELIGIBILITY DATES - Eligibility for the property tax deduction is established in the year prior to the calendar tax year
for which the deduction is claimed as follows:
New Jersey Citizenship as of October 1 pretax year
Property Ownership as of October 1 pretax year
Residence in New Jersey and in Dwelling House as of October 1 pretax year and
Residence in New Jersey for 1 year immediately prior to October 1 pretax year
Senior Citizen Age 65 or more as of December 31 pretax year
Permanent and Total Disability as of December 31 pretax year
Surviving Spouse/Surviving Civil Union Partner Age 55 or more as of December 31 pretax year and at the time of
spouse's/civil union partner’s death
3. CITIZEN & RESIDENT DEFINED - United States Citizenship is not required. Resident for purposes of this deduction
means a claimant who was legally domiciled in New Jersey for one year immediately prior to October 1 of the pretax
year. Domicile is the place you regard as your permanent home - the place you intend to return to after a period of
absence. You may have only one legal domicile even though you may have more than one residence. Seasonal or
temporary residence in this State, of whatever duration, does not constitute domicile. Absence from the State for a 12
month period is prima facie evidence of abandonment of domicile.
4. RESIDENCE IN DWELLING HOUSE DEFINED - Residence in the dwelling house means the dwelling where a
claimant makes his principal or permanent home. Vacation, summer or second homes do not qualify. Only one
deduction may be received per principal residence regardless of the number of qualified claimants residing on the
premises.
5. TENANCY BY ENTIRETY DEFINED - Tenancy by Entirety means ownership of real property by both husband and
wife or civil union partners, as a single ownership, in joint title acquired after marriage/civil union partnership.
6. INCOME DEFINED & LIMITED -
a.) The income period is the same tax year as the tax year for which a deduction is claimed.
b.) A claimant must reasonably anticipate that income received during the tax year, including income of the
claimant's spouse/civil union partner, will not exceed $10,000. Income of claimant's family members, other
than spouse/civil union partner, should not be included as annual income.
c.) Income means all income received from whatever source derived including, but not limited to, salaries, wages,
bonuses, commissions, tips, and other compensations before payroll deductions, all dividends, interest,
realized capital gains, royalties, income from rents, business income, and in their entirety, pension, annuity
and retirement benefits. Realized capital gains, except for capital gain from the sale or exchange of real
property owned and used by the claimant as his principal residence, dividends, interest, pensions, annuities
and retirement benefits must be included in full without deductions even though they may be wholly or
partially exempt for Federal income tax purposes.
EXCLUDABLE INCOME**Income can be excluded under ONE of the following three categories: Social Security
Benefits or Federal Government Retirement/Disability Pension including Federal Railroad Retirement Benefits or
State, County, Municipal Government and their political subdivisions and agencies Retirement/Disability Pension.
NOTE: In accordance with the Civil Union Act, eligibility guidelines that apply to married couples and surviving
spouses apply equally to civil union couples and surviving civil union partners.
Property Administration
Form PTD rev. 10/2019 Page 4 of 4
7. DOCUMENTARY PROOFS REQUIRED - Each assessor and collector may require such proofs necessary to establish
claimant's deduction entitlement and photocopies of any documents should be attached to this form as part of application
record. For example: AGE may be verified by birth certificate, baptismal record, family Bible, census record, marriage
certificate, court record, Social Security record, military record or discharge, immigration document, insurance policy,
DISABILITY may be verified by physician's certificate, Social Security document, New Jersey Commission for Blind
certificate. SURVIVING SPOUSE/SURVIVING CIVIL UNION PARTNER by death certificate of decedent. OWNERSHIP
by deed, executory contract for property purchase, last will and testament. RESIDENCY by New Jersey driver's license,
motor vehicle registration, voter's registration, State tax return.
8. ANNUAL POST-TAX YEAR INCOME STATEMENT REQUIRED - On or before March 1 of the year immediately
following the tax year for which deduction was claimed or received, a claimant must file a Post-Tax Year Income
Statement, Form PD5, confirming that annual income for the tax year did not exceed the $10,000 limit and that
anticipated annual income for the current year will not exceed that limit and that all other eligibility prerequisites
continue to be met. For example, the Post-Tax Year Income Statement filed by March 1, 2019 supports the claim for
deduction for tax year 2018 by confirming 2018 income. Anticipated income would refer to income received in tax year
2019 for the 2019 deduction. IF THIS INCOME STATEMENT IS NOT TIMELY FILED, DEDUCTION WILL BE
DISALLOWED AND CLAIMANT WILL BE BILLED FOR THE DEDUCTION AMOUNT.
9. APPEALS - A claimant may appeal any unfavorable determination by the assessor or collector to the County Board of
Taxation annually on or before April 1.
This form is prescribed by the New Jersey Division of Taxation, as required by law, and may be reproduced for
distribution, but may not be altered without prior approval.
PTD-SI
(Nov. 2011)
$250 REAL PROPERTY TAX DEDUCTION SUPPLEMENTAL INCOME FORM
(N.J.S.A. 54:4-8.40 et seq.; N.J.A.C. 18:14-1.1 et seq.)
THE BELOW INCOME DETAIL IS TO ENABLE THE COLLECTOR/ ASSESSOR TO DETERMINE WHICH ITEMS
MAY BE EXCLUDED UNDER THE LAW AND TO DETERMINE WHETHER YOU MEET THE INCOME
REQUIREMENTS OF THE LAW. THE ASSESSOR OR COLLECTOR MAY REQUEST THAT THIS INCOME
STATEMENT BE SUBSTANTIATED BY FEDERAL INCOME TAX RECORDS. FAILURE TO COMPLY MAY RESULT
IN LOSS OF YOUR SENIOR CITIZEN, DISABLED PERSON, SURVIVING SPOUSE, SURVIVING CIVIL UNION
PARTNER PROPERTY TAX DEDUCTION.
Re: _______________________________ ______________________________
(Applicant’s name) (Address)
The undersigned submits the following statement of income to aid in the determination of eligibility for a senior
citizen, disabled person, surviving spouse, or surviving civil union partner property tax deduction with respect to premises
located at:
_________________________________Block __________________Lot________________ Qualifier_______________
(County/Municipality)
INCOME FOR THE CALENDAR YEAR___________
*NOTE: If married, you must include spouse’s income
The tax assessor/collector will determine which of the below items will be EXCLUDED.
Applicant Spouse
1. Pension, Annuity, Retirement (PRIVATE) $__________________ $_________________
2. Salary/Wages/ Tips/Bonuses/Commissions __________________ _________________
3. Interest __________________ _________________
4. Dividends (Ordinary and Qualified) ___________________ _________________
5. IRA Distributions ___________________ _________________
6. Capital Gains ___________________ _________________
7. Business Income ___________________ _________________
8. Income from Rents/Royalties ____________________ _________________
9. Unemployment ____________________ _________________
10. Alimony ____________________ _________________
11. Other income ____________________ _________________
12. Social Security Benefits _____________________ _________________
13. Federal Pension/Railroad Pension ______________________ _________________
14. State, County, Municipal Pension ______________________ _________________
15. Disability Benefits ______________________ _________________
Total Yearly Income (sum of items 1-15) $_____________________
For Assessor/Collector Use Only
Excludable income $____________________ Total income after exclusion $____________________
I certify the above declarations are true to the best of my knowledge and belief and understand they will be
considered as if made under oath and subject to penalties for perjury if falsified.
_____________________________ ____________________________
(Applicant’s signature) (Spouse’s signature)
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CLAIM FOR REAL PROPERTY TAX DEDUCTION ON DWELLING (City Connections)

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Completed 23 January 2021

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