Application for Discount Land Rent
(for land rent leases first granted on or after 1 October 2013)
		
NOTES
•	This form should only be completed if the lessees entered the Land Rent Scheme under a land rent lease first granted on or after 1 October 2013. This is the date when the lease itself was first granted, and not the date that the land rent lease was transferred to the current owner.
•	Lessees must read the ‘Terms and Conditions’ in Section 4 of this form.  The meanings of words in bold are provided in the ‘Terms and Conditions’.
•	Lessee includes all lessees and proposed 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 the application being rejected. 

Details for Lessee 1 (primary contact)
Personal Details	
Title	Given name(s)	Family name	Marital status 	Name of Domestic Partner (if any)	

Current Residential Address	
Street Address	Suburb	State	Postcode	

Contact Details	
Telephone	Email	

Details for Lessee 2 (if applicable) 
Personal Details	
Title	Given name(s)	Family name	Marital status 	Name of Domestic Partner (if any)	

Current Residential Address	
Street Address	Suburb	State	Postcode	

Details of Property Subject to Land Rent
Suburb	Section	Block	Property 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 Information Privacy Act 2014.  Information (including personal information) is not disclosed to any third party unless authorised by law or with the consent of the person involved.	

Giving false or misleading information in a serious offence (Criminal Code 2002)	

SECTION 1	ELIGIBILITY 
The total gross annual income of all lessees, including the income of their domestic partner, must not exceed the income threshold amount.  The income assessment is based on lessee income and includes the income of any domestic partner. The income threshold is increased for each dependent child (up to 5 children). For current thresholds please see: http://www.revenue.act.gov.au/home-buyer-assistance/land-rent-scheme.
Does the total gross income of all lessees and their domestic partner exceed the income threshold amount? 	Yes    No	
Do any of the lessees own any other real property other than the subject property?	Yes    No	
Will at least one lessee occupy the property as his/her principal place of residence?	Yes    No	

SECTION 2	DEPENDENT CHILDREN
How many dependent children do the lessees have? (circle one)	0   1    2    3    4  
5 or more	
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 
All lessees and their domestic partner must list their total gross income from all sources received during the current year (to date) and the year prior to the date of the application. All forms of income must be declared, including Centrelink payments as these form part of the total gross income. Non-assessable Eligible Termination Payments, such as those made for years of service under a bona fide redundancy package, are excluded.  	
To substantiate your income details, each lessee and their domestic partner must provide the following (or a written reason for not providing these documents):	COPIES ATTACHED	
1.  evidence of total income for the current year (to date) and the year prior to the date     
     of the application (last year’s income tax return);	Yes     No  	
2.  a current pay slip from all jobs worked showing year to date totals, prior to the date of the application.  If your pay slips do not show year to date totals, provide copies of your last four (4) pay slips or a letter from your employer providing income details;	Yes     No  	
3.   if you are self-employed, a copy of all Business Activity Statements (BAS) for the current year (to date) and last year’s income tax return; and	Yes     No  	
4.   Centrelink statements or other income statements prior to the date of the application.	Yes     No  	
SECTION 3	INCOME DETAILS (continued) 

Income Details for Lessee 1
Total income as shown on:	Name of employer	Current year (to date) income	Prior year income	
Last year’s income tax return		Not Applicable		
Payslips			Not Applicable	
Centrelink statements			Not Applicable	
Other income statements			Not Applicable	
Total				

Income Details for Domestic Partner – Lessee 1 (if applicable)
Total income as shown on:	Name of employer	Current year (to date) income	Prior year income	
Last year’s income tax return		Not Applicable		
Payslips			Not Applicable	
Centrelink statements			Not Applicable	
Other income statements			Not Applicable	
Total				

Income Details for Lessee 2 (if applicable)
Total income as shown on:	Name of employer	Current year (to date) income	Prior year income	
Last year’s income tax return		Not Applicable		
Payslips			Not Applicable	
Centrelink statements			Not Applicable	
Other income statements			Not Applicable	
Total				

Income Details for Domestic Partner – Lessee 2 (if applicable)
Total income as shown on:	Name of employer	Current year (to date) income	Prior year income	
Last year’s income tax return		Not Applicable		
Payslips			Not Applicable	
Centrelink statements			Not Applicable	
Other income statements			Not Applicable	
Total				

NOTE	Use an additional form if there is more than two (2) lessees and their domestic partners.

SECTION 4	TERMS AND CONDITIONS
Application for Discount Land Rent: for land rent leases first granted on or after 1 October 2013

Each lessee and their domestic partner must read and understand this information before completing and submitting the application.

TERMS: 
Dependent Child	has the same meaning as in the Social Security Act 1991 (Cwlth). 	
Determined Rate	in relation to interest, means the rate determined under s 26 of the Taxation Administration Act 1999. 	
Discounted Land Rent	refers to the discount granted under part 3 of the Land Rent Act 2008.	
Domestic Partner	see the Legislation Act 2001, section 169.	
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 the instrument at http://www.revenue.act.gov.au/home-buyer-assistance/land-rent-scheme 	
Lessee	in relation to a proposed land rent lease, includes a person proposed to be a lessee under the lease.    Lessee refers to all individuals who appear on the land rent lease and who on completion of the purchase will be an owner of the subject property.  Lessee includes all lessees.	
Total Gross Income	means the total gross income of all persons named on the land rent lease, transfer or agreement for transfer of the subject property.	
Year	means a financial year. 	

CONDITIONS: 
•	Applications for discounted land rent may only be made on a single dwelling house land rent lease granted under the Planning and Development Act 2007.  	
•	Applications for discounted land rent must be made before the grant of the lease.  	
•	To be eligible for the discount, all applicants must be lessees who 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, and their domestic partner must not exceed the income threshold amount; and
-  if a certificate of occupancy is issued for the land rent lease – the lessee, or at least one of the lessees, must live in the property under the lease. 	
•	All lessees currently paying discounted land rent must lodge an Annual Review of Eligibility for Discounted Land Rent Form between 1 July and 30 September each year to demonstrate their continuing eligibility for discounted land rent. 
Loss of eligibility for discounted land rent because the total income of the lessee, or all of the lessees, and their domestic partner exceeds the income threshold amount for two (2) consecutive years or 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 the Commissioner for ACT Revenue giving each lessee a written notice that the lessee is not eligible to pay land rent.
If a lessee is given such a notice, the lessee must within two (2) years vary the lease to reduce the land rent payable to a nominal rent or transfer the lease to an eligible transferee.	
•	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 any outstanding land rent or interest must be paid in full prior to the property being sold.	
•	Lessees will be notified in writing whether or not they have been successful in their application.	
•	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 the ACT Revenue Office may prosecute any lessee found to have provided false or misleading information in an application.	

SECTION 5	DECLARATION AND UNDERTAKING
NOTE:	ALL LESSEES AND THEIR DOMESTIC PARTNERS MUST SIGN THE DECLARATION
I/we …………………………………………………...................................................................................... 
of ………………………………………………………………..................................... being the lessee/s and their domestic partner, declare that: 
1.	by signing this form I am making an application for discounted land rent;
2.	all of the information in this application including any attachments is true and correct, and to the best of my knowledge, no information relevant to the consideration of my application for discounted land rent 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’ in Section 4 of this application;
5.	I acknowledge that I have read and understood the Privacy Statement;
6.	I understand that, depending on the circumstances, interest may apply (on a compounding monthly basis) to any underpayment of land rent; and 
7.	I understand that giving false or misleading information is a serious offence under the Criminal Code 2002.
	
Lessee 1	Domestic Partner of Lessee 1 (if applicable)	
Signature:	Signature	
Date	Date	
Lessee 2 (if applicable)	Domestic Partner of Lessee 2 (if applicable) 	
Signature:	Signature	
Date	Date	

This is Approved form AF2014-132 under section 139C of the Taxation Administration Act 1999

Office use only	Lessee 1	$	
	Domestic Partner 1 (if applicable)	$	
	Lessee 2  (if applicable)	$	
	Domestic Partner 2 (if applicable)	$	
	Total Income for all Lessees and Domestic Partners	$	

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