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.
Name(s) of claimant owner(s) permanently residing in dwelling house.
2. DWELLING LOCATION
This deduction is claimed for the tax year_________________(indicate tax year).
**Complete 5b only if resident-tenant shareholder in Cooperative or Mutual Housing Corporation
Date of Birth
8. SENIOR OR DISABLED CITIZEN OR SURVIVING SPOUSE/SURVIVING CIVIL UNION PARTNER
(Choose A, B, or C)
9. REAL PROPERTY TAX DEDUCTION OTHER DWELLING I (and my souse/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
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.
$250 Real Property Tax Dedcution 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. FAILURE TO COMPLY MAY RESULT IN LOSS OF YOUR SENOR CITIZEN, DISABLED PERSON, SURVIVING SPOUSE, SURVIVING CIVIL UNION PARTNER PROPERTY TAX DEDUCTION.
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:
*NOTE: If married, you must include spouse's income
The tax assessor/collector will determine which of the below items will be EXCLUDED.