Form L-9 - Affidavit Requesting Real Property Tax Waiver(S) For A Resident Decedent - 2017

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RESIDENT DECEDENTS ONLY
L-9
L-9
1/17
Decedent’s Name: ___________________________________________________________________________________________________________
(Last)
(First)
(MI)
Decedent’s SS No. _____________________________ Date of Death (mm/dd/yy) ____________________ County of Residence ________________
This form may be used only if all beneficiaries are Class A, there is no New Jersey Inheritance or Estate Tax, and
there is no requirement to file a tax return.
PART I
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 Assets (mortgages, cash, personal property, etc.) . . . . . . . . . . . . . . . . . . . . . . . . . . .
$________________________
I. Gross estate (Total A thru H) (Line 1, Federal Estate Tax Form 706) . . . . . . . . . . . . . . . . .
$________________________
J. Adjusted Taxable Gifts (Line 4, 2001 Federal Estate Tax Form 706) . . . . . . . . . . . . . . . . .
$________________________
M. Total (I plus J) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$________________________
If the date of death is before January 1, 2017, AND the Total (Line M) is greater than $675,000, THIS FORM MAY NOT BE USED.
A New Jersey Estate Tax Return must be filed.
If the date of death is on or after January 1, 2017, AND the Gross Estate (Line I) is greater than $2 million, THIS FORM MAY NOT
BE USED. A 2017 New Jersey Estate Tax Return must be filed.
PART II
List all transfers made by the decedent within three years of date of death. (Attach additional sheets as needed.)
Date
Transferee/Beneficiary
Relationship
Property Transferred
Value
PART III
Full Assessed Value
Full Market Value
Description of New Jersey Real Estate
for Year of Death
at Date 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
3

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