Form L-9 Nr - Affidavit Form Of Non-Resident Decedent Requesting Real Property Tax Waiver(S) With Instructions Page 3

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L-9 NR
L-9 NR
NON RESIDENT DECEDENTS ONLY
2/07
Decedent’s Name: ___________________________________________________________________________________________________________
(Last)
(First)
(MI)
Decedent’s SS No. _____________________________ Date of Death (mm/dd/yy) ____________________ State of Domicile: ___________________
THE FOLLOWING QUESTIONS MUST BE ANSWERED:
1. The decedent died
Testate
Intestate
at _________________________________________________________________________________________________________
(Address)
_________________________________ _________________
on __________________________________________________
(City)
(State)
(Date)
A. The decedent’s actual place of residence was: ____________________________________________________________________
(Address)
Where he/she lived from _________________________________ to _________________________________
B. The decedent’s voting address was ____________________________________________________________________________
and he/she last voted in _________________________________
(Year)
C. The decedent’s last Income Tax Return listed his/her address as: _____________________________________________________
D. The decedent formerly lived in New Jersey at: ____________________________________________________________________
but moved to ______________________________________________________________ on _____________________________
(Address)
(Date)
2. Does the value of the decedent’s entire estate, wherever located, exceed $675,000?
Yes
No
Approximate value: $____________________________
3. Did the decedent own any assets, located anywhere, that were jointly owned with someone other than a
Class “A” beneficiary?
Yes
No
4. Did the decedent transfer any assets, located anywhere, to someone other than a Class “A” beneficiary during the 3 year period prior
to death?
Yes
No
If yes, explain ___________________________________________________________________
___________________________________________________________________________________________________________
5. Did the decedent transfer any asset at any time during his/her lifetime, in which he/she retained the use of the asset for the rest of
his/her lifetime?
Yes
No
If yes, explain ____________________________________________________________
___________________________________________________________________________________________________________
6. Did the decedent own any annuity contract(s) payable on death to someone other than a Class “A” beneficiary?
Yes
No

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