Form Ptr-1 - Property Tax Reimbursement Application - 2014 Page 3
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3PTR-1 (2014) Page 3
Name(s) as shown on PTR-1
Your Social Security Number
PRINCIPAL RESIDENCE
ß Homeowner
ß Mobile Home Owner
9. Status (fill in appropriate oval):
10. Homeowners: Enter the block and lot numbers of your 2014 principal residence.
Block
Lot
Qualifier
.
.
2013
2014
11a. Did you share ownership of your principal residence with anyone other
than your spouse/CU partner? (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/CU partner) (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/CU partner) occupy as your principal residence. . . . .
See instructions before completing Lines 13 and 14 if you:
l
Answered “Yes” at Line 11a or Line 12a; or
l
Received any deduction(s) and/or credit(s) on your property tax bills.
PROPERTY TAXES
Proof of Property Taxes Due and Paid for 2013 and 2014 Must be Submitted With Application.
See instructions.
13. Enter your total 2014 property taxes due and paid on your principal
residence. (For Mobile Home Owners, property taxes
13.
are your total site fees paid multiplied by 0.18). . . . . . . . . . . . . . . . . . .
,
.
14. Enter your total 2013 property taxes due and paid on your principal
residence. (For Mobile Home Owners, property taxes
14.
,
are your total site fees paid multiplied by 0.18). . . . . . . . . . . . . . . . . . .
.
(See “Impact of State Budget” on page 1 of instructions.)
REIMBURSEMENT AMOUNT
15.
15. Subtract Line 14 from Line 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
,
.
If Line 15 is zero or less, you are not eligible for a reimbursement and you should not file this application.
If enclosing copy of death certificate for deceased applicant, check box. (See instructions)
Due Date: June 1, 2015
Under the penalties of perjury, I declare that I have examined this Property Tax Reimbursement Application, including
Mail your completed
accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete.
application to:
If prepared by a person other than applicant, this declaration is based on all information of which the preparer has any
NJ Division of Taxation
knowledge.
Revenue Processing Center
_____________________________________________________ _______________________________________________________
Property Tax Reimbursement
Your Signature
Date
Spouse’s/CU Partner’s Signature (if applying jointly, BOTH must sign)
PO Box 635
Paid Preparer’s Signature
Federal Identification Number
Trenton, NJ 08646-0635
Property Tax Reimbursement
Firm’s Name
Federal Employer Identification Number
Hotline: 1-800-882-6597
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