Form A-3128 - Claim For Refund Of Estimated Gross Income Tax Payment Paid Page 2
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1
2Instructions for Form A-3128
1. This form is to be completed by nonresident individuals, estates or trusts to claim a refund of estimated
gross income tax payment paid under provisions of C. 55, P.L. 2004.
2. Separate forms must be used for each taxpayer, except for Husband & Wife that file jointly.
3. Include taxpayer's current address or address where refund should be mailed.
4. Include the address of property sold and the amount of refund being requested.
5. Check box indicating type of property use.
6. Include the Date of Sale, Sale Price, Date of Purchase, Federal Adjusted Basis, and Net Gain/Loss of the property sold.
7. Calculate and enter your estimated tax liability using the Table provided on the form.
Example:
** Use the Schedule below to determine your estimated tax liability.
** Taxpayers who submitted an erroneous payment and qualify for an exemption on the GIT/REP-3 Form -
Seller's Residency Certification/Exemption - enter $0. A completed copy of the GIT/REP-3 Form indicating your exemption status
must be attached.
Date Sold:
02/04/2005
Sale Price:
$300,000
Tax Rate Table
Net Gain
But Not
Estimated
Date Purchased: 09/21/2001
Federal Adjusted Basis:
$279,000
Over
Over
Multiply
Net Gain
by:
Tax Liability
$0
$20,000
x
__________
0.015
__________
Net Gain/Loss:
$21,000
$20,000
$35,000
x
$21,000
0.025
$525
(If Net Loss - enter $0.)
$35,000
$40,000
x
__________
0.035
__________
Estimated Gross Income Tax Payment submitted:
$6,000
$40,000
$75,000
x
__________
0.055
__________
$75,000
$500,000
x
__________
0.065
__________
$525
$500,000
and over
x
__________
0.085
__________
** Estimated Tax Liability Due:
$5,475
Amount of Refund Claim:
8. Include the estimated Gross Income Tax payment submitted.
** Payment of the Estimated Tax Liability does not relieve you of your responsibility to file the required return
nor does it close the tax year covered.
The tax year remains open until the required return has been filed and accepted, all tax, penalties,
and interest charges have been paid, and the statutory audit period has expired.
9. Enter the amount of your Net Refund being claimed.
10. Whenever an agent on behalf of the taxpayer executes a claim, an Appointment of Taxpayer Representative specifically
authorizing such agent to act on behalf of the taxpayer must accompany the claim for refund form.
11. Mail this claim for refund to:
New Jersey Division of Taxation
Taxpayer Accounting Branch
PO Box 046
Trenton, NJ 08646-0046
12. Failure to complete all required lines on Form A-3128 or to attach required documentation will result in the claim being rejected
as incomplete. Incomplete claims will be returned. Claims will not be deemed filed until the Divison of Taxation receives
a properly completed claim form.
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