Form Ptr-1 - Property Tax Reimbursement Application - 2014
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1
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3STATE OF NEW JERSEY
PTR-1
2014 PROPERTY TAX REIMBURSEMENT APPLICATION
ê You must enter your social security number below ê
Last Name, First Name and Initial
Your Social Security Number
(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)
County/Municipality Code (See instructions)
City, Town, Post Office
State
Zip Code
This is a three-page application. You must complete all three pages. Fill in ovals completely.
MARITAL/CIVIL UNION STATUS
ß Single
ß Married/CU Couple
1. Your Marital/Civil Union Status on December 31, 2013:
ß Single
ß Married/CU Couple
2. Your Marital/Civil Union Status on December 31, 2014:
AGE/DISABILITY STATUS
ß Yes
ß No
3a. On December 31, 2013, were you age 65 or older?
Yourself
ß Yes
ß No
Spouse/CU Partner
ß Yes
ß No
3b. On December 31, 2013, were you receiving
Yourself
ß Yes
ß No
Federal Social Security Disability Benefits?
Spouse/CU Partner
ß Yes
ß No
4a. On December 31, 2014, were you age 65 or older?
Yourself
ß Yes
ß No
Spouse/CU Partner
ß Yes
ß No
4b. On December 31, 2014, were you receiving
Yourself
ß Yes
ß No
Federal Social Security Disability Benefits?
Spouse/CU Partner
Applicant(s) must meet the age or disability requirements for both 2013 and 2014. If neither you nor your
spouse/CU partner met the requirements, you are not eligible for the reimbursement and you should not file this
application. See “Qualifications” on page 1 of instructions.
PROOF OF AGE OR DISABILITY FOR 2013 AND 2014 MUST BE SUBMITTED WITH APPLICATION
Age 65 or Older: Copy of Birth Certificate, Driver’s License, Church Records
Receiving Federal Social Security Disability Benefits: Copy of Social Security Award Letter
See instructions for more information.
RESIDENCY REQUIREMENTS
5. Have you lived in New Jersey continuously since December 31, 2003,
ß Yes
ß No
or earlier as either a homeowner or a renter?
If “No,” STOP. You are not eligible for the reimbursement and you should not file this application.
6. Have you owned and lived in the same New Jersey home since December 31,
ß Yes
ß No
2010, or earlier? (Mobile Home Owners, see instructions)
If “No,” STOP. You are not eligible for the reimbursement and you should not file this application.
CONTINUE TO PAGE 2 à
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