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 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____
___________________________
Net Property Tax Amount for Unit { } Co-op { } 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 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 AND
MARITAL STATUS
A. Date of Birth_____________________
B. { } Single ( ) Married { } Surviving Spouse { } Legally Separated/Divorced |
8. SENIOR OR DISABLED
CITIZEN OR SURVIVING SPOUSE (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 PHYSICIANS
OR SOCIAL SECURITY DISABILITY OR NEW JERSEY COMMISSION FOR BLIND CERTIFICATE.
C. { } I was a surviving spouse as of October 1 of the year prior
to the tax year and have not remarried. { } 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
death. **My deceased spouse 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) did not
receive a senior or disabled citizen or surviving spouse (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.
_______________________________ Date_________________
Signature of Claimant |
OFFICIAL USE ONLY - Block________Lot_____
Approved in the amount of $_________
{ } Age { } Disability { } Surviving Spouse of { } senior cirtizen or {
} disabled person
Assessor__________________________Date_______________
Form PTD rev. May 1996 |
