Home Buyer Concession Application Form 
for transactions between 1 July 2009 and 31 December 2009

NOTES - also see the guide to completing this application form on Page 4
•	An application must be received by the ACT Revenue Office within 90 days of the grant, transfer, or agreement for transfer (whichever is first).  For an Off the Plan purchase or an Affordable House and Land Package it must be received within 1 year of the grant, transfer, or agreement for transfer (whichever is first).  However, if one of the events happens under section 16A of the Duties Act 1999 the application must be received within 14 days of the event occurring.  Late applications will not be accepted.
•	To help determine if you qualify for a duty concession, please provide all details, ATTACH requested documents and tick the appropriate boxes.  Incomplete applications or applications lacking the required supporting information may result in the application being returned to you or the concession being denied.
•	If there are more than two applicants, complete and attach a second application form.
•	Applying for a concession does not stop interest from being applied if payment of the required duty is made after the due date.
Section 1	Applicant details	
Name of grantee/transferee	Marital status	Name of domestic partner (if any)	

Nominated contact (name)	Telephone (daytime)	Postal address	
			
Email address		
	Postcode	
Section 2	Property details	
Suburb	Section	Block	Unit	Purchase price 	Market value 	
				$	$	
Street address		

NOTE      If the buyer and seller are related parties, ATTACH a qualified valuer’s report to substantiate the current market value of the property.  Also ATTACH the original document/s for stamping.	
Is the property vacant land? 	YES	NO	
Date of grant/transfer or agreement for transfer (whichever is first)	      /       /       	
What % of the property is being purchased? 	                   %	
Are all grantees and transferees together acquiring a legal and an equitable interest in the property? 	YES	NO	

GIVING FALSE OR MISLEADING INFORMATION IS A SERIOUS OFFENCE (the Criminal Code 2002 applies)	
PRIVACY STATEMENT
All information collected by the ACT Revenue Office is protected by secrecy provisions in Acts administered by the Office and only used for the purposes of those Acts.  In addition, personal information provided to the ACT Revenue Office is protected by the Privacy Act 1988 (Cth).  Information (including personal information) is not disclosed to any third party unless authorised by law or with the consent of the person involved.

Section 3	Other interests in land	
At the date of the transaction (in Section 2), do any grantees/transferees or their domestic partners alone or jointly, hold a legal or equitable interest in land other than the subject property?	YES	NO	
Have any of the grantees/transferees or their domestic partners, either alone or jointly with another person/s, held a legal or equitable interest in land other than the subject property during the two years preceding the date of the transaction (in Section 2) of the subject property?	YES	NO	
If you answered YES to either question above, were you required to relinquish your interest by an order of a court, or a financial agreement, or a domestic relationship agreement, or a termination agreement as a consequence of a termination of a relationship between domestic partners, or was your interest held while performing your duties as an executor or trustee of a deceased estate?	YES	NO	
Section 4	Dependent children	
First name and surname	Age	First name and surname	Age	

				

NOTE       A ‘dependent child’ has the same meaning as in the Social Security Act 1991 (Cth).  If you have dependent children and wish to claim a combined total income between $120,000 and $136,650 (see Section 5) you must ATTACH a certified copy of the youngest child’s birth certificate.	
Section 5	Income details	
The following statement is to be completed and signed by each applicant and his/her domestic partner.  You as Applicant 1 must list all income from all sources received during the 1 year period prior to the date of the transaction declared in Section 2.  Non-assessable Employment Termination Payments (ETP), such as those made for years of service under a genuine redundancy package, are excluded.
However, if you have applied for a discount rate land rent lease, your application has been approved, and you have a domestic partner who is not on the lease as a lessee: 
1.	your domestic partner must complete the Income details for Applicant 2 in Section 5 and provide the specified supporting documentation;  and
2.	you do not need to provide the income details requested in this Section unless they are different from those submitted with your land rent application for discount.	
Income details for Applicant 1	
Type of income (e.g. wages, pensions, allowances, profits etc)	Name of employer
	Income received during the 1 year period prior to the date of the transaction in Section 2	
Wages		$	
Pensions		$	
Allowances		$	
Interest/dividends		$	
Other		$	
Less non-assessable ETP		- $	
Total 	$	

Income details for Applicant 2 or domestic partner (use an additional form if there is income from a third person)  	
Type of income (e.g. wages, pensions, allowances, profits etc)	Name of employer
	Income received during the 1 year period prior to the transaction date in Section 2	
Wages		$	
Pensions		$	
Allowances		$	
Interest/dividends		$	
Other		$	
Less non-assessable ETP		- $	
Total 	$	
Total Income for all applicants and domestic partners 	Office use only    $    	
Applicant 1	$	
Applicant 2	$	
For the 1 year before the transaction the total income from all sources was	$	
To substantiate your income details, each applicant and his/her domestic partner must ATTACH the following (or a reason for not providing these documents):
1.	evidence of total income for 1 year prior to date of transaction in Section 2;
2.	a copy of the last income tax return prior to the date of the transaction in Section 2 (not the notice of assessment);
3.	a copy of your loan application (not your loan approval); and
4.	if you are self-employed—a copy of all Business Activity Statements (BAS) for the 1 year period prior to the date of transaction in Section 2.
	
Section 6	Declaration and undertaking	
I/We declare that: 
1.	all applicants are over 18 years of age and at least one applicant will reside in the home as their principal place of residence for a continuous period of 6 months and such period is to commence within 1 year of:
(a)	the date of completion of the eligible transaction for an eligible property; or
(b)	the date of the certificate of occupancy following completion of construction of the residence on the eligible vacant block;
2.	all of the information in this application, and in any supporting documentation, is true and correct and that to the best of my/our knowledge, no information relevant to the consideration of my/our application has been omitted; and
3.	the income details provided are an indication of my/our usual income.
I/We understand that:
1.	in the event that I am/we are granted a concession, the Commissioner for ACT Revenue may issue an amended assessment if it is determined that I/we did not meet the relevant criteria for the concession granted (e.g. not meeting the residency requirements); 
2.	depending on the circumstances, interest and penalties may be applied to any unpaid duty; and
3.	giving false or misleading information is a serious offence and the Criminal Code 2002 applies.	
Signature of all applicants
NOTE  
All grantees/transferees and domestic partners must sign	Signature:	Date:	
	Full name:		
	Signature:	Date:	
	Full name:		

Guide to completing this application form
Note	All fields on the form must be completed
Section 1 
All persons who have an interest in the property must complete Section 1 of the application.  This includes domestic partners whether or not they have an interest in the property.
If details from more than two applicants are required, complete and attach another application form. 
Section 2 
If the buyer and seller are related parties, a qualified valuer’s report must be attached to substantiate the current market value of the property.  Duty is levied on the higher of the market value or the consideration paid for the property.
Section 3 
Indicate Yes or No in this section where required.
If you answered Yes to any question and you were required to relinquish your interest in land by an order of a court, a financial agreement, a domestic relationship agreement, or a termination agreement, attach a certified copy of the relevant court order or agreement. 
If you answered Yes to any question and your interest in land was held while performing your duties as an executor or trustee of a deceased estate, attach a certified copy of the relevant grant of Probate or Letters of Administration to the application. 
Section 4 
List all dependent children and their ages.  Provide a certified copy of the birth certificate of the youngest child if the total income of all applicants (see section 5) is higher than the lowest income threshold, and less than or equal to the highest income threshold. 
Section 5 
Show the income received by each applicant and domestic partner to enable the ACT Revenue Office to verify all details.
All forms of income must be included, for example, second jobs, back pay, baby bonus, maintenance payments.
If details from more than two applicants or domestic partners are required, complete and attach another application form.
The following information must be provided.  An explanation must be provided with the application if the information cannot be provided:
(a)	a copy of the payslips covering the month prior to the date of grant, transfer or agreement for transfer, for each applicant;
(b)	a full copy of the last income tax return prior to the date of grant, transfer or agreement for transfer, for each applicant (not the notice of assessment);  and 
(c)	a copy of the loan application (not the loan approval).
Note that you may be asked to provide additional information in order to determine your total income if necessary.
Section 6 
All grantees, transferees and their domestic partners must complete this section.  Each party must understand all details on the application form.
If details from more than two applicants are required, complete and attach another application form.