Affidavit of Resident Decedent Requesting Real Property Tax

09/04
L-9
AFFIDAVIT OF RESIDENT DECEDENT REQUESTING
REAL PROPERTY TAX WAIVER(S)
STATE OF NEW JERSEY
DEPARTMENT OF THE TREASURY
INDIVIDUAL TAX AUDIT BRANCH
TRANSFER INHERITANCE & ESTATE TAX
PO BOX 249
TRENTON, NEW JERSEY 08695-0249
(609) 292-5033
Forward this form to the Division of Taxation at the address listed above.
This form is not a waiver and is not to be filed with the County Clerk.
L-9
L-9
RESIDENT DECEDENTS ONLY
Decedent’s Name:
9/04
___________________________________________________________________________________________________________
(Last)
(First)
(MI)
Decedent’s SS No. _____________________________ Date of Death (mm/dd/yy) ____________________ County of Residence ________________
This form may be used only when all beneficiaries are Class “A”, there is no New Jersey Inheritance or Estate Tax and
there is no requirement to file a tax return.
For decedents dying after December 31, 2001 this form may be used only if the decedent's gross estate plus adjusted taxable gifts for
Federal estate tax purposes under the provisions of the Internal Revenue Code in effect on December 31, 2001 does not exceed
$675,000. The decedent’s gross estate plus adjusted taxable gifts consisted of the following:
A. Real estate wherever located (Full Market Value) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$________________________
B. Stocks and bonds whether held individually or jointly . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$________________________
C. Bank accounts whether held individually or jointly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$________________________
D. Individual Retirement Accounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$________________________
E. Pensions and Annuities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$________________________
F. Life insurance policies whether paid to a beneficiary or to the estate . . . . . . . . . . . . . . . . .
$________________________
G. Transfers intended to take effect in possession or enjoyment at or after death . . . . . . . . .
$________________________
H. Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$________________________
I.
Gross Estate (Total A thru H) (Line 1 of 2001 Federal Estate Tax Form 706) . . . . . . . . . . .
$________________________
J. Adjusted Taxable Gifts (Line 4 of 2001 Federal Estate Tax Form 706) . . . . . . . . . . . . . . . .
$________________________
M. Total (I plus J) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$________________________
IF THE TOTAL (LINE M) IS GREATER THAN $675,000, DO NOT PROCEED. THIS FORM MAY
NOT BE USED. A NEW JERSEY ESTATE TAX RETURN MUST BE FILED.
List all transfers made by the decedent within three years of date of death:
Date
Transferee/Beneficiary
Relationship
Description of New Jersey Real Estate
Property Transferred
Full Assessed Value
for Year of Death
Street and Number
Municipality
County
Lot
Block
Owner(s) of Record: (If decedent owned a fractional interest state how held and fractional value thereof).
Amount of Mortgage Balance (if any)
$
Street and Number
Municipality
County
Lot
Block
Owner(s) of Record: (If decedent owned a fractional interest state how held and fractional value thereof).
Amount of Mortgage Balance (if any)
$
RIDERS MAY BE ATTACHED WHERE NECESSARY
Value
Full Market Value
at Date of Death
Beneficiaries
State Full names of all who have an interest in the Estate
(vested, contingent, operation of law, transfer, etc.)
Relationship to the Decedent
Interest of Beneficiary in the Estate
Deponent further states the following schedule contains the names of all beneficiaries who predeceased the decedent.
Date of Death
Name
Domicile at Death
If this form is not fully and properly completed and/or it does not have the required attachments, it will be returned. Did you remember to:
†
Use the current version of this form.
†
Answer all questions.
†
Fill in the decedent’s date of death and social security number.
†
Attach a copy of letters testamentary or letters of administration.
†
Attach a copy of the decedent’s will, codicils, and any trust agreements.
†
Attach a copy of the decedent’s last full year’s Federal income tax return including Schedule A, B, and D.
†
Fully describe the realty to include the owner of record and the street number, municipality, lot, block, county, and the assessed
and market values on the decedent's date of death. If an appraisal was made of the realty, attach a copy. If the realty was held
by multiple owners, state the names of the joint owners, their relationship to the decedent and whether the realty was held as
tenants in common or as joint tenants with right of survivorship. A tax waiver is not necessary and will not be issued for real
property held by a husband and wife as tenants by the entirety in the estate of the spouse dying first.
†
List all beneficiaries who shared in the estate whether by will, intestacy, trust, operation of the law, transfer intended to take
effect in possession or enjoyment at or after death or by transfer within three years of death. Indicate the relationship of each to
the decedent and their interest in the estate.
†
In the case of a surviving Domestic Partner, attach a copy of the stamped Certificate of Domestic Partnership issued by the local
registrar bearing the seal of the State of New Jersey. If the domestic partnership was entered into outside this State, this form
may not be used.
Complete and Notarize
Mailing Address
To Send
All Correspondence
Name _________________________________________________ Phone (
) ___________________
Street _________________________________________________________________________________
City
___________________________________________ State __________ Zip ___________________
State of: ____________________________________________
County of: __________________________________________
That ____________________________________________________________________________ being duly sworn, has reviewed the
information contained in this form and declares to the best of his/her knowledge it is true, correct, and complete. Deponent authorizes the
party listed above to act as the estate's representative and to receive the waiver(s) requested herein.
Subscribed and sworn before me
this _________ day of _____________________, 20______
___________________________________________________________
(Signature of Notary Public or Attesting Officer)
Affidavit of:
†Executor
† Administrator
† Joint Tenant
_____________________________________________
Signature of Deponent
INSTRUCTIONS
Form L-9 is an affidavit executed by the executor, administrator or joint tenant requesting the issuance of a tax waiver for real
property located in New Jersey which was held by a resident decedent.
Form L-9 may not be used if any of the following conditions exist:
†
Any asset valued at $500 or more passes to a beneficiary other than the decedent’s parents, grandparents, spouse, domestic
partner (provided that the relationship was entered into in New Jersey), children, legally adopted children, children’s issue,
legally adopted children’s issue or stepchildren by will, intestacy, trust, operation of the law, by transfer intended to take effect in
possession or enjoyment at or after death or by transfer within three years of death.
†
Where a trust agreement exists or is created under the terms of the decedent’s will. In the event that all other conditions for the
use of Form L-9 are met and there is no possibility that any portion of the trust assets will pass other than to a Class “A”
beneficiary, the Division may give consideration to the issuance of a real estate tax waiver.
†
The relationship of a mutually acknowledged child is claimed to exist.
†
A domestic partnership, civil union, or reciprocal beneficiary relationship is claimed to exist and the relationship was entered into
in a jurisdiction other than New Jersey.
†
Where the decedent’s date of death is after December 31, 2001 and his/her gross estate plus adjusted taxable gifts for Federal
estate tax purposes under the provisions of the Internal Revenue Code in effect on December 31, 2001 exceeds $675,000.
†
In any instance where there is a New Jersey inheritance or estate tax or a tax return is required to be filed.
This form is not a tax waiver and is not to be filed with the County Clerk.
This competed form and attachments should be forwarded to the NJ Division of Taxation, Inheritance and Estate Tax, PO Box 249,
Trenton, NJ 08695-0249.
Additional information pertaining to the use of Form L-9 may be obtained by calling the Inheritance and Estate Tax Section at 609292-5033.
THIS FORM MAY BE REPRODUCED IN ITS ENTIRETY