Payment Plan Form-Individuals - New Jersey
Payment Plan Request Form - Individuals
Use This Form to Request a Payment Plan for Individual Income Taxes. Do Not Use This Form for Business Taxes, Unpaid Cigarette Taxes or Property Relief Programs.
Personal Information
Name: __________________________________________________________________________________________________________
Last
First
Address: _________________________________________________________________________________________________________
Street Address
Apartment/Unit #
______________________________________________________________________________________________________
City
State
ZIP Code
Home Phone:
Daytime Phone
Email Address: _______________________________________________________________________________________________
Primary Social Security Number: ____________________________________________________________________________
Secondary Social Security Number: _________________________________________________________________________
Payment Information
Balance Due (if known): ___________________________________________________ Requested Monthly Payment: $___________________________________________ Preferred Monthly Due Date: _____________________________________________
We Will Review and Adjust Your Payment Plan Request Form, if Needed
Taxpayer Signature: _________________________________________________________Date: _________________________________
Make check payable to: New Jersey Division of Taxation
To Make a Payment Online Visit:
Complete This Form, Sign, and:
Fax to: 609-341-2706; or
Mail to: New Jersey Division of Taxation Payment Plan Unit PO Box 190 Trenton, NJ 08695-0190; or
Email to: PaymentPlanUnit@treas.
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