Fillable Rates Rebate Application Form Application for the rating (Department of Internal Affairs New Zealand)

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Rates Rebate Application Form Application for the rating (Department of Internal Affairs New Zealand)

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The Rates Rebate Application Form Application for the rating (Department of Internal Affairs New Zealand) form is 3 pages long and contains:

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Country of origin: NEW-ZEALAND
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1. Name – You must be named on your local council’s rating information database (RID) to be eligible.
First names:
Last name:
2. Address – The property you pay rates for must be your usual place of residence on 1 July 2021.
You cannot claim a rates rebate on a property that is used principally for business, farming, commercial or industrial purposes,
or a home that is not your usual place of residence.
Street number and name:
Suburb and town:
Postcode:
Postal address (if dierent):
Best phone number:
Email:
Were you living with a spouse/partner* or joint home owner(s) on 1 July 2021?
Yes No
*By marriage, civil union or de facto relationship
If yes, include their income in section 4.
Do you earn money from home or run a business from home?
Yes No
If yes, how?
If yes, include income in section 4.
Were you living at this address on 1 July 2021?
Yes No
If yes, go to section 3.
Did you move here from another property after 1 July 2021?
Yes No
If yes, what is the address of your previous property? ...........................................................................................................
............................................................................................................
What date did you settle the sale of your previous property? ......................................
How much did you pay in rates on your previous property for this rating year? $....................................
Did you receive any rebate on those rates? Yes $........................... No
Rates Rebate
Application Form
Application for the rating year 1 July 2021 to 30 June 2022
TA Ref:
Council use only
Applications close on 30 June 2022 and cannot be accepted after this date
Unique Property ID
Council use only
3. Dependants - Must have been living with you on 1 July 2021. Your spouse/partner is not a dependant.
These are:
• children you care and provide for under the age of 18 on 1 July 2021 who at this time were not married, in a civil union or de facto
relationship and you were not receiving payments for them under section 363 of the Oranga Tamariki Act 1989
• relatives in receipt of a benet (but not NZ Superannuation) on 1 July 2021.
Last name First names Birth date Benet type (if applicable)
4. Income Declaration – For the tax year 1 April 2020 to 31 March 2021.
Satisfactory proof of income may be required and includes:
• income conrmation from Work and Income
• income conrmation from Inland Revenue
• investment earning statement for the tax year
• statement of earnings from your employer
Additionally for self employed people:
• a copy of your complete set of nancial accounts, IR3B or
IR10 you provided to Inland Revenue for the income year 1
April 2020 to 31 March 2021
• business losses cannot be oset against other income
• business losses should be entered as $0
In the table below, show the total income, before tax, that you and your spouse/partner and/or joint homeowner received for
the tax year 1 April 2020 to 31 March 2021. Indicate your occupation and tick the relevant boxes to show the source(s).
Occupation: ...........................................................................................................
New Zealand Superannuation Self-employment Employment Jobseeker
Supported Living Sole Parent
Other (specify): .............................................................................
.............................................................................
Source of income (enter gross amounts unless otherwise indicated) Your income (no commas)
Partner/joint homeowner
income (no commas)
New Zealand Superannuation $ $
Personal superannuation $ $
Interest / dividends $ $
Wages or salary $ $
Work and Income benets $ $
Work and Income supplements (e.g. Accommodation Supplement) $ $
Working for Families Tax Credits (excludes Family Tax Credits) $ $
Net prot before tax from any business – enter ‘0’ if you sustained
a loss
$ $
Rental income - enter ‘0’ if you sustained a loss $ $
ACC earnings compensation $ $
Trust income paid to you $ $
Overseas income (converted to $NZ) $ $
Income from other sources $ $
Individual total
$ $
Total combined income $
0
0
0
RR103/104 08/2021
5. Rates – Refer to your 2021/22 rates notices to complete this section.
Show the total amount you pay for local, regional and council water rates (if applicable) on your home. Your council or retirement
village operator will be able to help you with this information.
Local council rates $
Council Use only
Regional council rates $
Council water rates $
Total rates $
6. Important Information
Rates rebates are granted under the Rates Rebate Act 1973. You must provide the requested information on this form so your
rebate can be worked out. Your council will process the application. You have the right to see this information, and have it corrected.
Contact your local council if you have any questions about the assessment of your rates rebate.
Section 14 of the Rates Rebate Act 1973
14. Oences
(1) Every person commits an oence who-
(a) for the purpose of obtaining any rates rebate under this Act, for himself or for any other person, makes any statement or verication
knowing it to be false in any particular, or wilfully misleads or attempts to mislead any person concerned in the administration of this
Act or any other person whatsoever; or
(b) refuses or fails to comply with any requirement under section 11, or refuses or fails to answer any question put to him pursuant to
that section, or knowingly gives any false or misleading answer to any such question.
(2) Every person who commits an oence against this Act is liable on conviction before a District Court Judge to imprisonment for a term not
exceeding 12 months or to a ne not exceeding $500, or to both.
7. Declaration
I ...................................................................................................................................................................................
(name in full)
of ..................................................................................................................................................................................
...................................................................................................................................................................................
(residential address)
...................................................................................................................................................................................
I certify that the information I have given in this application is, to the best of my knowledge, true, complete and correct. I understand
that if i have knowingly provided false or misleading statements or information I can, by law, be ned up to $500, or imprisoned for
12 months, or both.
• Take or post this form to your council once completed. Some councils may accept forms
via email, check your local council's website for more information.
• Council staff will work out your rebate
• Note that applications close on 30 June 2022 and cannot be accepted after this date.
What Next?
Signature
Date signed
/ /
0
Applying for a rates rebate
1 July 2021 to 30 June 2022
The purpose of the Rates Rebate Scheme is to provide a subsidy to low income home owners on the cost
of their rates. The maximum rebate for this rating year is $665.
Am I eligible?
□ I am the legal ratepayer for the property that is my usual place of residence on 1 July 2021. The property is not used
principally for commercial, industrial, business or farming purposes.
□ I am applying on, or between, 1 July 2021 to 30 June 2022.
Can people living in retirement villages apply?
Most retirement village residents are able to apply. If you hold a licence to occupy agreement, a separate form is required
to be lled in by the retirement village operator and must be included with this form. Contact your village operator or local
council for more information.
Can owners of owner-occupier ats apply?
An owner-occupier at forms part of a group of two or more dwellings that are separately owned by the occupants, but
built on a single rating unit. The rates are shared by the owners. If you are the owner of an owner-occupier at, you might
be eligible for a rebate. You will need to complete a separate rates rebate owner-occupier form which can be obtained
from your local council, or downloaded from www.govt.nz/rates-rebates. Once completed, the form should be submitted
with this application form.
Can residents of trust owned properties apply?
Only if you are a named trustee and are also named on the council Rating Information Database (RID)
How much will my rebate be?
Your council will calculate your rates rebate. The Rates Rebates Act tells the council how to calculate your rates rebate.
The amount of your rebate depends on the rates payable, you and your spouse/partner’s (if applicable) income and the
number of dependents living with you. To check what your entitlement might be, refer to the table or visit www.govt.nz/
rates-rebates to enter your details into the rates rebate calculator.
Rates rebate income eligibility table for households with no dependants. Estimate only.
Household
Income
Level of Rates
$1,250 $1,500 $1,750 $2,000 $2,250 $2,500 $2,750 $3,000 $3,250 $3,500 $3,750 $4,000
Rates Rebate
$26,000
$665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00
$27,000
$665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00
$28,000
$540.67 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00
$29,000
$415.67 $582.33 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00
$30,000
$290.67 $457.33 $624.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00
$31,000
$165.67 $332.33 $499.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00
$32,000
$40.67 $207.33 $374.00 $540.67 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00
$33,000
− $82.33 $249.00 $415.67 $582.33 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00
$34,000
− − $124.00 $290.67 $457.33 $624.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00
$35,000
− − − $165.67 $332.33 $499.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00
$36,000
− − − $40.67 $207.33 $374.00 $540.67 $665.00 $665.00 $665.00 $665.00 $665.00
$37,000
− − − − $82.33 $249.00 $415.67 $582.33 $665.00 $665.00 $665.00 $665.00
$38,000
− − − − − $124.00 $290.67 $457.33 $624.00 $665.00 $665.00 $665.00
$39,000
− − − − − − $165.67 $332.33 $499.00 $665.00 $665.00 $665.00
$40,000
− − − − − − $40.67 $207.33 $374.00 $540.67 $665.00 $665.00
$41,000
− − − − − − − $82.33 $249.00 $415.67 $582.33 $665.00
$42,000
− − − − − − − − $124.00 $290.67 $457.33 $624.00
$43,000
− − − − − − − − − $165.67 $332.33 $499.00
$44,000
− − − − − − − − − $40.67 $207.33 $374.00
$45,000
− − − − − − − − − −
$82.33 $249.00
$46,000
− − − − − − − − − −
− $124.00
$47,000
− − − − − − − − − − − −
QUESTIONS: If you have any questions about the Scheme contact your local council or visit
www.govt.nz/rates-rebates
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Rates Rebate Application Form Application for the rating (Department of Internal Affairs New Zealand)

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