Form PTD rev. February 2007
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.
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2. DWELLING LOCATION
________________________________________________________________________________________________________________________
Street Address of resident owner claimant's dwelling. (Unit # if Co-op)
________________________________________________________________________________________________________________________
County & Municipality
________________________________________________________________________________________________________________________
Block / Lot / Qualifier
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3. YEAR OF DEDUCTION This deduction is claimed for the tax year________________ (indicate tax year).
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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.
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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.
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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.
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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
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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
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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_____________________
Form PTD rev. February 2007
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 2007, the
pretax year filing period would be October 1 - December 31, 2006 with the assessor and the tax year filing period would be
January 1 - December 31, 2007 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.
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, 2008 supports the claim for deduction for tax year 2007 by
confirming 2007 income. Anticipated income would refer to income received in tax year 2008 for the 2008 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.
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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.
$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.
FA1LURE
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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