ACT Revenue Office
Department of Treasury	

Annual Review of Eligibility for Discounted Land Rent
Form must be submitted between 1 July and 30 September

NOTE
•	Lessees must read the ‘Terms and Conditions’ at the end of this form.  The meaning of words in bold is provided in the ‘Terms and Conditions’.
•	Lessee includes all lessees and all lessees must complete and sign the form.  If there are more than two lessees, an additional form must be completed and attached to the original form.
•	Lessees must provide the required details and must complete all sections of the form.  Incomplete declarations or declarations without the required supporting information may result in discontinuation of the discount rate of land rent. 

Details for lessee 1 (primary contact)
Personal details	
Title	Given name(s)	Family name	

Current residential address	
Street Address	Suburb	State	Postcode	

Contact details	
Telephone	Email	

Details for lessee 2
Personal details	
Title	Given name(s)	Family name	

Current residential address	
Street Address	Suburb	State	Postcode	

Details of property subject to Land Rent
Suburb	Section	Block	Street address	Postcode	

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 (Commonwealth).  Information (including personal information) is not disclosed to any third party unless authorised by law or with the consent of the person involved.

Section 1	Eligibility
Does the total income of all lessees exceed the income threshold amount?	Yes    No	
Do any of the lessees own any other real property other than the subject property?	Yes    No	
Does at least one lessee occupy the property as his/her principal place of residence?	Yes    No	
How many dependent children do the lessees have? (circle one)	0 1  2  3  4  5 or more	

Section 2	Dependent children
First Name and Surname	Date of birth (dd/mm/yy)	First Name and Surname	Date of birth (dd/mm/yy)	
1.		4.		
2.		5.		
3.		6.		

Section 3	Income details 
NOTE  	You must list your total income from all sources received during the year prior to the date of the review, excluding 
non-assessable Eligible Termination Payments such as those made for years of service under a bona fide redundancy package. 
You must also attach supporting documentation for the income you declare e.g. copy of income tax return for previous financial year, pay slips for previous financial year, Centrelink statements for previous financial year

Income details for lessee 1
Total income as shown on	Name of employer	Prior year income	
Last income tax return			
Centrelink statements			
Other income statements			
Other			
Total			

Income details for lessee 2
NOTE	Use an additional form if there is income from any another person 
Total income as shown on	Name of employer	Prior year income	
Last income tax return			
Centrelink statements			
Other income statements			
Other			
Total			

Office use only	Lessee 1	$	
	Lessee 2	$	
	Total Income for all sources		

Section 4	Declaration and undertaking
NOTE	All lessees must sign
I/we …………………………………………………...................................................................................... 
of ……………………………………………………………… being the lessee/s, declare that: 
1.	by signing this form I am making a declaration of my continuing eligibility for discounted land rent;
2.	all of the information in this declaration including any attachments is true and correct, and to the best of my knowledge, no information relevant to the consideration of my declaration has been omitted;
3.	the income details I have provided are an indication of my usual income (attach copies);
4.	I have read and understood the ‘Terms and Conditions’ at the end of this form and I understand that, depending on the circumstances, interest may apply to any underpayment of Land Rent.
I understand that giving false or misleading information is a serious offence under the Criminal Code 2002.
I also acknowledge that I have read and understood the Privacy Statement.	
Lessee 1	
Signature:	Date:	
Lessee 2	
Signature:	Date:	

GIVING FALSE OR MISLEADING INFORMATION IS A SERIOUS OFFENCE (section 338 Criminal Code 2002)	

Office use only	Delegate name	Signature	Date	
				
	Unimproved value	Land rent account number	Approved	
	$		Rejected	

 
Terms and Conditions 
Annual Review of Eligibility for Discounted Land Rent

NOTE	Each lessee MUST read and understand this information before completing and submitting the declaration form.
Conditions
•	Declarations about a lessee’s continuing eligibility for discounted land rent may only be made on a single dwelling house land rent lease granted under the Planning and Development Act 2007.  	
•	The declaration for the annual review of a lessee’s continuing eligibility for discounted land rent must be made between 
1 July and 30 September each year.	
•	To be eligible for a further term of discounted land rent, all lessees must meet the following criteria:
-  the lessee, or any of the lessees, must not own other real property; and 
-  the total income of the lessee, or all of the lessees, must not exceed the income threshold amount; and
-  the lessee, or at least 1 of the lessees, must live on the property under the land rent lease. 	
•	All lessees of the property must lodge an Annual Review of Eligibility for Discounted Land Rent Form to demonstrate their continuing eligibility for discounted land rent. 
A lessee who is determined to be ineligible for discounted land rent because the total income of the lessee, or all of the lessees, exceeds the income threshold amount, will commence paying Land Rent at the standard (non-discounted) rate from 1 October after the Annual Review period (1 July to 30 September).
Loss of eligibility for discounted land rent because one of the lessees becomes the owner of other real property or all of the lessees stop living on the subject property will result in Land Rent being payable at the standard rate, effective from the 1st quarter after the circumstance has occurred. 	
•	Lessees acknowledge that if a land rent lease is transferred, land rent will be payable at the standard percentage of the unimproved value of the property under the land rent lease.	
•	Lessees acknowledge that interest will accrue on the amount of unpaid Land Rent at the determined rate from the day the amount becomes payable until the day the amount is paid.  If an amount remains unpaid for part of a month then interest is payable for the whole of the month.  For example:
Andrew’s land rent is due on 1 April.  He doesn’t pay it until 15 May.  Andrew has to pay interest worked out for the overdue period from 2 April to 15 May.  Because of the operation of section 22 (2) of the Land Rent Act 2008, Andrew has to pay interest for the period 2 April to 1 June. 	
•	Lessees acknowledge that any outstanding land rent or interest will be held as a charge against the property under the land rent lease.	
•	Lessees acknowledge that all outstanding Land Rent and interest must be paid in full prior to the property being sold.	
•	Lessees will be notified in writing whether or not their continuing eligibility for discounted land rent has been approved.	
•	Lessees are required to notify the ACT Revenue Office if they no longer reside in the property, or become the owner of other real property, within 30 days of the change in circumstance.	
•	Lessees acknowledge that giving false or misleading information is a serious offence under the Criminal Code 2002 and that the ACT Revenue Office may prosecute any lessee who provides false or misleading information in a declaration.	

Terms 
Dependent Child	has the same meaning as in the Social Security Act 1991 (Cth)	
Determined Rate	in relation to interest, means the rate determined under s 139 of the Taxation Administration Act 1999	
Discounted Land Rent	refers to the discount granted under part 3 of the Land Rent Act 2008 	
Income Threshold Amount	means the income threshold amount with reference to the number of dependent children the lessees  have as specified in the instrument applicable at the time of declaration: see copy of the instrument at www.revenue.act.gov.au 	
Lessee	Lessee refers to all individuals who appear on the land rent lease.  Lessee includes all lessees.	
Total Income	means the total income of all persons named on the land rent lease, transfer or agreement for transfer of the subject property	
Year	means a financial year