Form PD5 "Annual Post-tax Year Income Statement" - New Jersey

What Is Form PD5?

This is a legal form that was released by the New Jersey Department of the Treasury - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2011;
  • The latest edition provided by the New Jersey Department of the Treasury;
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  • Fill out the form in our online filing application.

Download a fillable version of Form PD5 by clicking the link below or browse more documents and templates provided by the New Jersey Department of the Treasury.

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Download Form PD5 "Annual Post-tax Year Income Statement" - New Jersey

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Form PD5 (rev. Jan. 2011)
ANNUAL POST-TAX YEAR INCOME STATEMENT OF QUALIFIED NEW JERSEY RESIDENT SENIOR CITIZEN,
DISABLED PERSON, OR SURVIVING SPOUSE/SURVIVING CIVIL UNION PARTNER REQUIRED TO CONTINUE
RECEIPT OF REAL PROPERTY TAX DEDUCTION ON DWELLING HOUSE (N.J.S.A. 54:4-8.40 et seq.; L. 1963, c. 172 as
amended) (N.J.A.C. 18:14-1.1 et seq.) P.L. 2006, Chapter 103, the Civil Union Act, effective February 19, 2007.
SEE REVERSE SIDE
This INCOME STATEMENT must be filed with the
FOR INSTRUCTIONS
municipal tax collector timely by March 1 annually or it
will result in loss of the deduction and you will be billed
1.
NAMES OF REAL PROPERTY
for the deducted amount.
TAX DEDUCTION RECIPIENT(S)
A)
B)
CLAIMANT’S SS# AND SPOUSE’S/CIVIL UNION
PARTNER’S SS# if applicable
Claimant’s
Social Security #
Spouse’s/Civil Union Partner’s
Social Security #
2. LOCATION OF CLAIMED DWELLING HOUSE
Municipality of:
County of:
Street Address
or Unit Number:
Parcel Key:
Block:
Lot:
Qualifier:
Name and Address of Cooperative or
Mutual Housing Corporation, if applicable:
3. CONFIRMATION OF INCOME FOR TAX YEAR FOR WHICH DEDUCTION WAS GRANTED
I declare and confirm that the total annual income I (and my spouse/civil union partner combined) received from all
sources after permitted income exclusion, during the previous calendar tax year: _____________ (year)
DID NOT exceed $10,000.
DID exceed $10,000.
See Reverse Side for Definition of Income and
Excludable Income Defined
4. ESTIMATION OF ANTICIPATED INCOME FOR CURRENT TAX YEAR
I reasonably anticipate that the total annual income I (and my spouse/civil union partner combined) will receive from
all sources, after permitted income exclusion, during the current calendar tax year ____________________ (year)
WILL NOT exceed $10,000.
WILL exceed $10,000.
5. REAFFIRMATION OF ELIGIBILITY
I reaffirm that all information provided on the initial CLAIM FORM PTD concerning New Jersey domicile or legal
residence, principal residence in and ownership of the above identified dwelling house as of October 1 pretax year,
i.e., the year prior to the calendar tax year, as well as personal data; i.e., age, disability, marital/civil union status
as previously filed with the municipal tax assessor and/or collector is true and accurate and remains unchanged
except as listed below.*
CHOOSE A, B, or C.
A.
As a surviving spouse/surviving civil union partner, I have not remarried/entered into a new civil union partnership.
B.
As a permanently and totally disabled person, I also reaffirm that my disability status has not changed.
C.
I initially applied as a senior citizen, age 65 or more.
*List below any changes in domicile, residence or occupancy, ownership, marital/civil union status, disablement etc.;
if none, state "none":
________________________________________________________________________________________________
________________________________________________________________________________________________
I certify the above declarations are true to the best of my knowledge and belief and understand they will be considered as
if made under oath and subject to penalties for perjury if falsified. I authorize the State of New Jersey,
Division of Taxation to conduct a review of my Federal and State Income Tax and any income/eligibility data
provided for other property tax benefits in order to verify my eligibility for the senior citizen/disabled
person/surviving spouse/civil union partner property tax deduction.
Signature of Claimant
Date
WARNING
Failure to timely file this statement with the collector or to submit proof of income as he or she requires OR where annual
income exceeds the statutory limit will result in disallowance of the previously granted deduction or jeopardize its
continuation. Disallowed deductions must be repaid on or before June 1 of the post-tax year or become delinquent, a lien
on the property and a personal debt of the claimant.
=============================================================================
Approved
OFFICIAL
Disapproved
_______________________________________________________________
USE
Signature of Collector
Date
ONLY
Form PD5 (rev. Jan. 2011)
ANNUAL POST-TAX YEAR INCOME STATEMENT OF QUALIFIED NEW JERSEY RESIDENT SENIOR CITIZEN,
DISABLED PERSON, OR SURVIVING SPOUSE/SURVIVING CIVIL UNION PARTNER REQUIRED TO CONTINUE
RECEIPT OF REAL PROPERTY TAX DEDUCTION ON DWELLING HOUSE (N.J.S.A. 54:4-8.40 et seq.; L. 1963, c. 172 as
amended) (N.J.A.C. 18:14-1.1 et seq.) P.L. 2006, Chapter 103, the Civil Union Act, effective February 19, 2007.
SEE REVERSE SIDE
This INCOME STATEMENT must be filed with the
FOR INSTRUCTIONS
municipal tax collector timely by March 1 annually or it
will result in loss of the deduction and you will be billed
1.
NAMES OF REAL PROPERTY
for the deducted amount.
TAX DEDUCTION RECIPIENT(S)
A)
B)
CLAIMANT’S SS# AND SPOUSE’S/CIVIL UNION
PARTNER’S SS# if applicable
Claimant’s
Social Security #
Spouse’s/Civil Union Partner’s
Social Security #
2. LOCATION OF CLAIMED DWELLING HOUSE
Municipality of:
County of:
Street Address
or Unit Number:
Parcel Key:
Block:
Lot:
Qualifier:
Name and Address of Cooperative or
Mutual Housing Corporation, if applicable:
3. CONFIRMATION OF INCOME FOR TAX YEAR FOR WHICH DEDUCTION WAS GRANTED
I declare and confirm that the total annual income I (and my spouse/civil union partner combined) received from all
sources after permitted income exclusion, during the previous calendar tax year: _____________ (year)
DID NOT exceed $10,000.
DID exceed $10,000.
See Reverse Side for Definition of Income and
Excludable Income Defined
4. ESTIMATION OF ANTICIPATED INCOME FOR CURRENT TAX YEAR
I reasonably anticipate that the total annual income I (and my spouse/civil union partner combined) will receive from
all sources, after permitted income exclusion, during the current calendar tax year ____________________ (year)
WILL NOT exceed $10,000.
WILL exceed $10,000.
5. REAFFIRMATION OF ELIGIBILITY
I reaffirm that all information provided on the initial CLAIM FORM PTD concerning New Jersey domicile or legal
residence, principal residence in and ownership of the above identified dwelling house as of October 1 pretax year,
i.e., the year prior to the calendar tax year, as well as personal data; i.e., age, disability, marital/civil union status
as previously filed with the municipal tax assessor and/or collector is true and accurate and remains unchanged
except as listed below.*
CHOOSE A, B, or C.
A.
As a surviving spouse/surviving civil union partner, I have not remarried/entered into a new civil union partnership.
B.
As a permanently and totally disabled person, I also reaffirm that my disability status has not changed.
C.
I initially applied as a senior citizen, age 65 or more.
*List below any changes in domicile, residence or occupancy, ownership, marital/civil union status, disablement etc.;
if none, state "none":
________________________________________________________________________________________________
________________________________________________________________________________________________
I certify the above declarations are true to the best of my knowledge and belief and understand they will be considered as
if made under oath and subject to penalties for perjury if falsified. I authorize the State of New Jersey,
Division of Taxation to conduct a review of my Federal and State Income Tax and any income/eligibility data
provided for other property tax benefits in order to verify my eligibility for the senior citizen/disabled
person/surviving spouse/civil union partner property tax deduction.
Signature of Claimant
Date
WARNING
Failure to timely file this statement with the collector or to submit proof of income as he or she requires OR where annual
income exceeds the statutory limit will result in disallowance of the previously granted deduction or jeopardize its
continuation. Disallowed deductions must be repaid on or before June 1 of the post-tax year or become delinquent, a lien
on the property and a personal debt of the claimant.
=============================================================================
Approved
OFFICIAL
Disapproved
_______________________________________________________________
USE
Signature of Collector
Date
ONLY
Form PD5 (revised January 2011)
FORM PD5
GENERAL INSTRUCTIONS
1. FILING PROCEDURE - On or before March 1 of the post-tax year, deduction recipients MUST file this Income
Statement with the municipal tax collector to confirm that annual income for the preceding tax year did not exceed
the $10,000 limit, after permitted income exclusion, and that anticipated income for the current tax year will not
exceed $10,000. Deduction recipients must also confirm that all other eligibility conditions continue to be met.
2. APPLICABLE INCOME PERIOD - The income period is the same tax year as the tax year for which the
deduction was claimed or received. For example, an Annual Post-Tax Year Statement to be filed on or before
March 1, 2011 should support the deduction claim for tax year 2010 by confirming actual 2010 income. It should
also support the current deduction claim for tax year 2011 by estimating 2011 anticipated income.
3. EXTENSION OF TIME FOR FILING THIS INCOME STATEMENT - Where illness or medical problem, as
certified by a physician's statement, prevents timely filing of the Annual Post-Tax Year Income Statement the
collector may at his or her discretion grant a reasonable extension of time to file but no later than May 1 of the
post-tax year.
4. INCOME DEFINED - N.J.S.A. 54:4-8.40(a) defines "income" as all income from whatever source derived
including, but not limited to, realized capital gains except for a capital gain resulting from the sale or exchange of
real property owned and used by the taxpayer as his principal residence...and, in their entirety, pension, annuity
and retirement benefits.
N.J.A.C. 18:14-1.1 defines "income" as salaries, wages, bonuses, commissions, tips and other
compensations before payroll deductions, all dividends, interest, realized capital gains, royalties, income from
rents, business income and, in their entirety, pension, annuity and retirement benefits. Realized capital gains,
except for capital gain resulting from the sale or exchange of real property owned and used by the taxpayer as his
principal residence,...and dividends, interest, pensions, annuities and retirement benefits must be included in full
without deductions even though they may be wholly or partially exempt for Federal income tax purposes.
N.J.A.C. 18:14-1.1 further defines "business income" as gross income derived from a business, trade,
profession or the rental of property after deductions of the ordinary and necessary expenses of the business, trade,
profession or rental of property allowed under the Federal Internal Revenue Code and regulations.
"Disability benefits," the New Jersey Constitution and statutes are silent on the subject of disability income
other than those disability benefits received under a Federal, State, or Political Subdivision program which are
excludable only to the extent of the maximum benefit received under the Federal Social Security Act. Therefore,
any other disability income received should be evaluated for inclusion or exclusion based on its proper treatment
for Federal Income Tax purposes.
"Married/civil union person’s income," income received by the applicant and spouse/civil union partner is
combined in establishing eligibility for the property tax deduction unless they are living separately.
N.J.S.A. 54:4-8.41 provides, in part, income of a married/civil union person includes an amount equal to the
income of the spouse/civil union partner during the applicable income year, except for that portion of the year as
the two were living apart in a state of separation, whether under judicial decree or otherwise.
N.J.A.C. 18:14-1.1 also provides income of claimant's family members other than a spouse/civil union
partner is not to be combined with income of claimant.
NOTE: In accordance with the Civil Union Act, eligibility guidelines that apply to married couples and
surviving spouses apply equally to civil union couples.
5. EXCLUDABLE INCOME DEFINED - Benefits are excludable under only ONE of three categories:
1. The Federal Social Security Act and all its amendments and supplements;
2. Any other Federal government program or Federal law which provides benefits in whole and in part in
lieu of Social Security benefits or for persons excluded from coverage under Social Security, including
but not limited to the Federal Railroad Retirement Act and Federal pension, disability and retirement
programs;
3. Pension, disability or retirement programs of any state or its political subdivisions, or agencies for
persons not covered under Social Security.
** NOTE: Where the claimant and/or spouse/civil union partner receives only Social Security benefits and
no benefits under 2. & 3., the amount of Social Security received can be deducted from income in full.
Where the claimant and/or spouse/civil union partner receives both Social Security benefits and
government retirement/disability benefits under 2. or 3., the larger of either one of the income
categories can be deducted but any government pension/disability benefit deduction cannot exceed the
maximum allowable Social Security benefit. The amount of federal, state, county, municipal pension,
disability or retirement benefit etc. excluded should be based on actual benefits received provided that
the total excluded under 2. or 3. above is not in excess of the maximum benefit amount excludable in
similar circumstances under 1. Social Security. N.J.S.A. 54:4-8.40(a) (1) (2) (3).
6. DOCUMENTARY PROOFS REQUIRED - Each collector may require any information necessary to establish
claimant's deduction entitlement.
7. DISALLOWANCE - Failure to timely file this statement or meet income and other eligibility requirements will
result in disallowance of the deduction. Claimants will be notified by formal Notice of Disallowance. Disallowed
deductions must be repaid on or before June 1 of the post-tax year or where a filing extension was granted no later
than thirty days after mailing of the Notice of Disallowance. If unpaid, taxes will be delinquent, constitute a lien on
the property and a personal debt of claimant.
8. APPEALS - Disallowed claims may be appealed to the county board of taxation.
*********************************************************************************************************************************
This form is prescribed by the New Jersey Division of Taxation, as required by law, and may be reproduced for
distribution but may not be altered without prior approval.
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