Form Ptr-1 - Property Tax Reimbursement Application - 2006
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2STATE OF NEW JERSEY
PTR-1
2006 PROPERTY TAX REIMBURSEMENT APPLICATION
WEB
You must enter your social security number below
Your Social Security Number
Last Name, First Name and Initial
(Joint applicants enter first name and initial of each - Enter spouse last name ONLY if different)
Spouse’s Social Security Number
Home Address (Number and Street, including apartment number or rural route)
City, Town, Post Office
State
Zip Code
County/Municipality Code (See Table page 10)
1. Residency Status:
Homeowner
Mobile Home Owner
2. Your Marital Status on December 31, 2005:
Single
Married
3. Your Marital Status on December 31, 2006:
Single
Married
4a. On December 31, 2005, I (or my spouse) was
Age 65 or older
Receiving Federal Social Security Disability Benefits.
4b. On December 31, 2006, I (or my spouse) was
Age 65 or older
Receiving Federal Social Security Disability Benefits.
You must provide proof that the age or disability requirements were met for both 2005 and 2006. See reverse for acceptable forms of
proof. If you (or your spouse) did not meet the age or disability requirements, you are not eligible for the reimbursement and you
should not file this application.
5. Did you live in New Jersey continuously since before January 1, 1996, as either a homeowner or a renter?
Yes
No. If “No,”
STOP. You are not eligible for the reimbursement and you should not file this application.
6. Did you own and live in your New Jersey home (or lease a site in a mobile home park in New Jersey on which you placed a
manufactured or mobile home that you own) since before January 1, 2003?
Yes
No. If “No” STOP. You are not eligible for the
reimbursement and you should not file this application.
7. Complete Income Worksheet A (on reverse) and enter the amount of 2005 Total Income
7.
,
.
from Line r. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8. Complete Income Worksheet B (on reverse) and enter the amount of 2006 Total Income
8.
,
from Line r. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.
9. Enter the address for which you are claiming the reimbursement if different from above.
Street address ____________________________________________________ Municipality ______________________________
10. Homeowners: Enter the block and lot number of the residence for which the property tax reimbursement is being claimed.
Block
Lot
Qualifier
2005
2006
11a. Did you share ownership of your principal residence with anyone
other than your spouse? (Mobile Home Owners see instructions.) . . . . . . . . . . . . . . .
Yes
No
Yes
No
11b. If you answered “Yes,” indicate the share (percentage) of the property
%
%
owned by you (and your spouse) (Mobile Home Owners see instructions.) . . . . . . . . .
12a. Does your principal residence consist of more than one unit? . . . . . . . . . . . . . . . . . . .
Yes
No
Yes
No
12b. If you answered “Yes,” indicate the share (percentage) of the property
%
%
that you (and your spouse) occupy as your principal residence. . . . . . . . . . . . . . . . . .
If you answered “Yes” at Line 11a or Line 12a, be sure to read the instructions on pages 7 - 9
before you complete Lines 13 and 14.
13.
Enter your total 2006 property taxes due and paid on your principal residence. (Mobile
.
,
13.
Home Owners enter 18% of total 2006 site fees due and paid $________________ x .18)
14.
Enter your total 2005 property taxes due and paid on your principal residence. (Mobile
14.
Home Owners enter 18% of total 2005 site fees due and paid $________________ x .18)
,
.
REIMBURSEMENT AMOUNT
.
,
15.
15. Subtract Line 14 from Line 13. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If Line 15 is zero or less, you are not eligible for a property tax reimbursement and you should not file this application.
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Division Use
Under the penalties of perjury, I declare that I have examined this Property Tax Reimbursement Application, including accompanying schedules
Due Date: June 1, 2007
and statements, and to the best of my knowledge and belief, it is true, correct, and complete. If prepared by a person other than applicant,
Mail your completed application to:
this declaration is based on all information of which the preparer has any knowledge.
NJ Division of Taxation
________________________________________________________ ______________________________________________________
Revenue Processing Center
Your Signature
Date
Spouse’s Signature (if applying jointly, BOTH must sign)
Property Tax Reimbursement
Paid Preparer’s Signature
Federal Identification Number
PO Box 635
Trenton, NJ 08646-0635
Firm’s Name
Federal Employer Identification Number
Property Tax Reimbursement
Hotline: 1-800-882-6597
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