Form L-9 - Affidavit Of Resident Decedent Requesting Real Property Tax Waiver(S) - State Of New Jersey Department Of The Treasury Page 2

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L-9
L-9
RESIDENT DECEDENTS ONLY
1/07
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 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
Property Transferred
Value
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

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