Fillable Form Ptr-1 - Property Tax Reimbursement Application

PTR-1

STATE OF NEW JERSEY

2001 PROPERTY TAX REIMBURSEMENT APPLICATION

THIS IS NOT A HOMESTEAD REBATE APPLICATION

ê ê You must enter your social security number below ê ê

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 9)

1. RESIDENCY STATUS:

Homeowner

Mobile Home Owner

TO BE ELIGIBLE FOR THE REIMBURSEMENT YOU MUST:

A. Be age 65 or over OR receiving Federal Social Security disability benefits;

If you did not satisfy requirements A through D

B. Own a home OR lease a site in a mobile home park;

for both 2000 and 2001 you are not eligible for

C. Be domiciled in New Jersey for at least 10 consecutive years and have been a

the reimbursement and you should not file this

homeowner or tenant during that time;

application. If you satisfied requirements A

D. Have owned and lived in the home for which the reimbursement is being claimed

through D for both 2000 and 2001 you must

for at least the last 3 years;

now complete the worksheets on the back to

E. Have total annual income in 2000 of less than $37,174, if single or, if married, have

determine whether you also satisfy the income

total annual income combined with spouse less than $45,582.

requirements in E and F.

F. Have total annual income in 2001 of less than $38,475, if single or, if married, have

total annual income combined with spouse less than $47,177.

2. Enter the amount of 2000 Total Income from Worksheet A, Line p. (See reverse) . . . . . . . . . . . . . .

3. 2000 Marital Status:

Single

Married

4. Did you meet all of the eligibility requirements as of December 31, 2000? If “Yes” check the box

and proceed to Worksheet B. If “No” you

are not eligible for the reimbursement and you should not file this application.

5. Enter the amount of 2001 Total Income from Worksheet B, Line p. (See reverse)

. . . . . . . . . . . . . . . .

6. 2001 Marital Status:

Single

Married

7. Did you meet all of the eligibility requirements as of December 31, 2001? If “Yes” check the box

. If “No” you are not eligible for the

reimbursement and you should not file this application.

8. Enter the address for which you are claiming the reimbursement if different from above.

Street address ____________________________________________________________ Municipality ___________________________________

9. Homeowners: Enter the block and lot number of the residence for which the property tax reimbursement is being claimed.

Block

Lot

Qualifier

10. Enter your total 2001 property taxes due and paid on your principal residence.

10.

(Mobile Home Owners enter 18% of total 2001 site fees due and paid $___________________ x .18)

11. Enter your total 2000 property taxes due and paid on your principal residence.

11.

(Mobile Home Owners enter 18% of total 2000 site fees due and paid $___________________ x .18)

REIMBURSEMENT AMOUNT

12. Subtract Line 11 from Line 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12.

If Line 12 is less than or equal to zero you are not eligible for a property tax reimbursement and you should not file this application.

Division

Use

Under the penalties of perjury, I declare that I have examined this Property Tax Reimbursement Application, including accompanying

Due Date: March 15, 2002

schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. If prepared by a person other than

Mail your completed application to:

applicant, 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

Tax Reimbursement Hotline:

1-800-882-6597

Form Ptr-1 - Property Tax Reimbursement Application - 2001

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