Form Ptd - 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

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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
________________________________________________________________________________________________________________________
Block / Lot / Qualifier
***********************************************************************************************************************
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.
************************************************************************************************************************
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_____________________
Form PTD rev. February 2007

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