Form L-9(A) – Affidavit for Real Property Tax Waiver(s): Resident Decedent 

                                 Use this form for dates of death before 1/1/2018 
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).

Youmay not 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 morepasses to any beneficiary other than 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 his/her gross estate, plus adjusted taxable
        gifts, exceeds $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 his/her
        gross estate exceeds $2,000,000 as determined for Federal Estate Tax purposes under the provisions of the
        current Internal Revenue Code. (A 2017 New Jersey Estate Tax  return must be filed);
   •    When 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 this completed form to: 
        NJ Division of Taxation 
        Inheritance and Estate Tax Branch 
        3 John Fitch Way, 6th Floor 
        PO Box 249 
        Trenton, NJ 08695-0249 

You can obtain more information about the use of Form L-9(A) by calling the Inheritance and Estate Tax Branch 
at (609) 292-5033 or by visiting the Division of Taxation website atnj.gov/taxation.
                                        This Form May Be Reproduced in its Entirety. 

(11/19) 

                                                                Form L-9(A) 

Decedent’s Name ___________________________________________________________________________________________________________________ 
                   (Last)                                                (First)                                                    (MI) 
Decedent’s SS No.                                Date of Death (mm/dd/yyyy)                                 County of Residence 
This form may be usedonly ifall beneficiaries areClass 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 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. 
                                              You must file a New Jersey Estate Tax Return. 
If 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, this form may not be used. 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) 
                                                                                                       Property 
        Date              Transferee/Beneficiary                   Relationship                                                         Value 
                                                                                                Transferred 

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

    Mailing Address                Name_____________________________                               ______        __     Phone (        ) _______________________ 

    To Send                        Street ___________________________________________________________________________________________ 

    All Correspondence             City ___________________________________________________State ___                           _____Zip ______________  ___ 
                                                                                                                                                                   
  State of:                                                                                       County of:                                                      
  (Deponent’s name)                                                                                                           ,  being duly sworn, has reviewed the 
  information contained in this form and declares to the best of his/her 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 this ______ day of_______  ______, _______. Affidavit of:      Executor     Administrator                    Joint Tenant        
     ________________________________________         ______________________________________________ 
                 (Signature of Notary Public or Attesting Officer)                                 Signature of Deponent 

            ___________________________________________________________________________________         _______________________________________________________________________________________________
                       Print Name                                                                  Deponent’s SS number or FID number 

                                                                                                        _______________________________________________________________________________________________ 
                                                                                                                               Address 

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