New Jersey Division of Taxation
NJ-0911
Gross Income Tax Forgiveness for Victims of the
September 11, 2001 Terrorist Attacks
PLEASE SEE THE INSTRUCTIONS FOR ASSISTANCE IN COMPLETING THIS REQUEST FORM. PLEASE PRINT.
DECEDENT’S LAST NAME
FIRST NAME
MI
DECEDENT’S SOCIAL SECURITY NUMBER
SURVIVING SPOUSE’S LAST NAME
FIRST NAME
MI
SURVIVING SPOUSE’S SOCIAL SECURITY NUMBER
NAME AND TITLE OF PERSON CLAIMING A REFUND ON BEHALF OF THE DECEDENT TAXPAYER
MAILING ADDRESS
APARTMENT NUMBER
CITY
STATE
ZIP CODE
For decedents with returns filed as Single (filing status 1), Married filing separate return (filing status 3), Head of
PART I
Household (filing status 4) or Qualifying widow(er) with dependent child (filing status 5).
FIRST ELIGIBLE YEAR
SECOND ELIGIBLE YEAR
2000
2001
Enter the total New Jersey Gross Income Tax from the decedent’s income tax return, Line 40
on the NJ-1040 or Line 23 on the NJ-1040NR. This is the amount of tax to be forgiven . . . . . . .
PART II
For decedents with returns filed as Married filing join return (filing status 2).
FIRST ELIGIBLE YEAR
SECOND ELIGIBLE YEAR
2000
2001
1. Enter the decedent’s taxable income, computed as if a separate return was filed. . . . . . . . . .
2. Enter the decedent’s total tax computed on line 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . .
3. Enter the surviving spouse’s taxable income, computed as if a separate return was filed.
4. Enter the surviving spouse’s total tax computed on line 3. . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. Add lines 2 and 4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. Enter the total tax from the joint return (line 40 on the NJ-1040 or line 23 on the NJ-1040NR)
7. Divide line 2 by line 5. Carry the result to four decimal places. . . . . . . . . . . . . . . . . . . . . . . .
8. Multiply line 6 by line 7. This is the amount of tax to be forgiven. . . . . . . . . . . . . . . . . . . . . .
The New Jersey Division of Taxation will determine the amount to be refunded.
Under penalties of perjury, I declare that I have examined this return, including accompanying 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 taxpayer, this declaration is based on all information of
which the preparer has any knowledge.
_______________________________________________________________________________________________________________________________
Signature
Date
For Private Delivery Service :
New Jersey Gross Income
For US Postal Service:
New Jersey Gross Income
(Such As FedEx or UPS)
Tax Forgiveness Unit
Tax Forgiveness Unit
Office of the Director
Office of the Director
NJ Division of Taxation
NJ Division of Taxation
50 Barrack Street
PO Box 240
Trenton NJ 08695
Trenton NJ 08695-0240
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