Affidavit for Real Property Tax Waiver  
 L-9(A)                                              Resident Decedent 
     (9/22)
                                  Use this form for dates of death before January 1, 2018

 Decedent’s Name  
                               Last                                                First                                                               Middle Initial

 Decedent’s SSN.          –          –               Date of Death (mm/dd/yyyy)  /  /     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:       Testate (with will)                                          Intestate (no will)
 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 lines A through H) (line 1, federal estate tax form 706) .....................................                               $ 
 J. Adjusted taxable gifts (line 4, 2001 federal estate tax form 706).....................................................                           $ 
 M. Total (line I plus line J) ..................................................................................................................... $ 
 Do not use this form if:
 •  The date of death is before January 1, 2017, and the total (line M) is greater than $675,000. You must file a New Jersey Estate 
     Tax Return. 
 •  The date of death is on or after January 1, 2017, but before January 1, 2018, and the gross estate (line I) is greater than $2 
     million. You must file a 2017 New Jersey Estate Tax Return.

 Part II
 List all transfers made by the decedent within three years of date of death (attach additional sheets as needed)
     Date of Transfer             Transferee/Beneficiary        Relationship              Property Transferred                                         DOD Value

 Part III
                                                                                   Full Assessed Value for                                             Full Market Value at Date 
             Description of New Jersey Real Estate
                                                                                       Year of Death                                                   of Death
 County
 Street and Number
 Lot                                   Block
 Municipality
 Owner(s) of Record (if decedent owned a fractional interest, state how it is 
 held, and the fractional value or percentage):

                                                     Riders may be attached when necessary

                     Beneficiaries
                                                                                                        Interest of Beneficiary in the 
State full names of all who have an interest in the estate      Relationship to Decedent
     (vested, contingent, operation of law, transfer, etc.)                                      Estate (percentage or specific)

Deponent (person making deposition) further states the following schedule contains the names of all beneficiaries who predeceased the
decedent.
                          Name                                  Date of Death                           Domicile at Death

This form will be returned if it is not fully and properly completed and/or it does not have the required attachments.
Include all of the required documentation with this form:
•  Copy of the decedent’s will, codicils and related writings, and any trust agreements;
•  Copy of the deed for the property listed on the form;
•    Copy of executor’s or administrator’s certificate;
•    Copy of the decedent’s death certificate;
•    Copy of the decedent’s last full-year federal income tax return (or statement that none was filed);
•  Copy of any existing appraisals or current contracts of sale.

                                                         Complete and Notarize

                     Name                                                                               Phone (       ) 
Mailing address for 
all correspondence   Street 

                     City                                                               State           ZIP Code 

State of                                                        County of 

(Deponent’s name)                                                                        being duly sworn, has reviewed the infor-
mation contained in this form and declares to the best of their knowledge it is true, correct, and complete. Deponent authorizes the party 
listed above to act as the estate’s representative and to receive the waiver(s) requested herein.
Subscribed and sworn before me 
                                                                Affidavit of:   Executor                 Administrator   Joint Tenant
This        : day of           , 20               .

(Signature of Notary Public or Attesting Officer)               Signature of Deponent

Print Name                                                      Deponent’s Social Security or Federal Identification Number

                                                                Address

                                    Form L-9(A) Instructions 
This form can be completed by:
•  The executor;
•  Administrator; or
•  Joint tenant of the property for which a waiver is requested.

Eligibility
All beneficiaries of this estate must be one of the following Class A beneficiaries:
•  Spouse or civil union partner;
•  Child (includes legally adopted child), grandchild, great-grandchild, etc.;
•  Parent or grandparent;
•  Step-child (but not step-grandchildren);
•  Domestic partner (on or after 7/10/04).

You cannot use Form L-9(A) if any of the following conditions exist:
•  The real estate was held as “tenants by the entirety” (jointly by spouse/civil union partner) and the spouse/civil 
    union partner is surviving. 
    Note: No waiver is needed for this property, and none will be issued;
•  Any asset valued at $500 or more passes to any beneficiary other than the Class A beneficiaries listed above;
•  A trust agreement exists or is created under the terms of the decedent’s will;
•  The relationship of a mutually acknowledged child is claimed to exist;
•  The decedent’s date of death is before January 1, 2017, and their gross estate, plus adjusted taxable gifts, ex-
    ceeds $675,000 as determined for federal estate tax purposes under the provisions of the Internal Revenue Code in 
    effect on December 31, 2001. A New Jersey Estate Tax return must be filed;
•  The decedent’s date of death is on or after January 1, 2017, but before January 1, 2018, and their gross estate 
    exceeds $2 million as determined for federal estate tax purposes under the provisions of the current Internal Reve-
    nue Code. A 2017 New Jersey Estate Tax return must be filed;
•  There is any New Jersey Inheritance Tax or Estate Tax due.

Required Documents
•  Copy of the decedent’s will, codicils and related writings, and any trust agreements;
•  Copy of the deed for the property listed on the form;
•   Copy of executor’s or administrator’s certificate (letters of testamentary or of administration);
•   Copy of the decedent’s death certificate; 
•  Copy of the decedent’s last full-year federal income tax return. (Include Schedules A, B, and D or statement that 
    none was filed);
•  Copy of any existing appraisals or current contracts of sale.

This form is not a tax waiver. Do not file with the County Clerk. Mail to:
Regular Mail and USPS Express Mail
NJ Division of Taxation
Transfer Inheritance Tax
PO Box 249
Trenton, NJ 08695-0249

Express Mail – Private Carriers (UPS, FedEx)
NJ Division of Taxation
Transfer Inheritance Tax
PO Box 249
3 John Fitch Way, 6th Floor
Trenton, NJ 08611

For more information about the use of Form L-9(A), call the Inheritance and Estate Tax Branch at (609) 292-5033 or visit 
the Division of Taxation website at nj.gov/taxation.