Form Ptr-1 - Property Tax Reimbursement Application

STATE OF NEW JERSEY

PTR-1

2009 PROPERTY TAX REIMBURSEMENT APPLICATION

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/CU partner last name ONLY

if different)

Spouse’s/CU Partner’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/Civil Union Status on December 31, 2008:

Single

Married/CU Couple

3. Your Marital/Civil Union Status on December 31, 2009:

Single

Married/CU Couple

4a. On December 31, 2008, I (or my spouse/CU partner) was

Age 65 or older

Receiving Federal Social Security Disability Benefits.

4b. On December 31, 2009, I (or my spouse/CU partner) 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 2008 and 2009. See reverse for acceptable forms of

proof. If you (or your spouse/CU partner) 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, 1999, 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, 2006?

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 2008 Total Income

from Line r. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8. Complete Income Worksheet B (on reverse) and enter the amount of 2009 Total Income

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 numbers of the residence for which the property tax reimbursement is being claimed.

Block

Lot

Qualifier

2008

2009

11a. Did you share ownership of your principal residence with anyone

other than your spouse/CU partner? (Mobile Home Owners see instructions.) . . . . . .

Yes

11b. If you answered “Yes,” indicate the share (percentage) of the property

owned by you (and your spouse/CU partner) (Mobile Home Owners see instructions.)

12a. Does your principal residence consist of more than one unit? . . . . . . . . . . . . . . . . . . .

Yes

12b. If you answered “Yes,” indicate the share (percentage) of the property

that you (and your spouse/CU partner) occupy as your principal residence. . . . . . . . .

If you answered “Yes” at Line 11a or Line 12a, be sure to read the instructions on pages 8-9 before you complete Lines 13 and 14.

13.

Enter your total 2009 property taxes due and paid on your principal residence. (For

13.

Mobile Home Owners, property taxes are your total site fees paid multiplied by 0.18) . . . .

14.

Enter your total 2008 property taxes due and paid on your principal residence. (For

14.

Mobile Home Owners, property taxes are your total site fees paid multiplied by 0.18) . . . .

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.

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, 2010

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, this

Mail your completed

declaration is based on all information of which the preparer has any knowledge.

application to:

______________________________________________________

_______________________________________________________

NJ Division of Taxation

Your Signature

Date

Spouse’s/CU Partner’s Signature (if applying jointly, BOTH must sign)

Revenue Processing Center

Paid Preparer’s Signature

Federal Identification Number

Property Tax Reimbursement

PO Box 635

Trenton, NJ 08646-0635

Firm’s Name

Federal Employer Identification Number

Property Tax Reimbursement

Hotline: 1-800-882-6597

Form Ptr-1 - Property Tax Reimbursement Application - 2009

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