Form A-3730 - Claim For Refund

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A-3730
State of New Jersey
7-96, R-9
DIVISION OF TAXATION
CLAIM FOR REFUND
File this Claim With:
For Official Use Only
Division of Taxation
CN 019
Claim No.
Trenton, N.J. 08646-0019
Please print or type / See Instructions On Reverse Side
DO NOT USE THIS FORM FOR GROSS INCOME TAX (Individual)
Name of Taxpayer
Trade Name
Number and Street
City
State
Zip Code
COMPLETE ALL APPLICABLE ITEMS
Federal Identification Number OR Social Security Number
Name and Address on Return (if different from above)
Type of Tax
Period Covered by claim
Date of Payment
Amount of Claim
If tax is reported on an annual basis, complete a separate claim for each taxable year.
EXPLANATION OF CLAIM
Submit supporting documents to substantiate claim. A separate claim must be filed for refund of each tax. If space is insufficient, submit
additional sheet(s).
I
declare under the penalties of perjury that this claim (including any accompanying schedules and statements) has been examined by me and to the best of my
knowledge and belief is true and correct.
_________________________________________________________
Name of Taxpayer (See Instruction 3)
Date _____________________________________
Signed by: _________________________________________________________
_________________________________________________________
Title

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