A-3730                                                     State of New Jersey                                                 For Official Use Only
(11-10)
                                                           Division of Taxation                                        Claim No.
                                       CLAIM FOR REFUND - BUSINESS TAXES ONLY

                                         Please Print or Type / See Instructions On Reverse Side
                                       DO NOT USE THIS FORM FOR GROSS INCOME TAX (Individual)
                                                    COMPLETE ALL APPLICABLE ITEMS
SECTION ONE
1a.  Name of Taxpayer                                                  1b.  Trade Name

All correspondence related to this claim will be mailed to the address listed in 2a, 2b, 2c, and 2d below.  If you are using a Taxpayer 
Representative, you must submit the Taxpayer Representative’s address on the Appointment of Taxpayer Representative form (M-5008-R).
2a.  Number and Street                                                 2b.  City                                    2c.  State        2d.  Zip Code

3. FID Number or Social Security Number 4. Name and Address on Return (if different from above)

5. Type of Tax                          6. Period Covered by Claim     7. Date of Payment                           8. Amount of Claim

SECTION TWO
                                                        EXPLANATION OF CLAIM
In accordance with N.J.A.C. 18:2-5.8, submit a detailed explanation as well as all supporting documentation to substantiate this claim.  If space is
insufficient, submit additional sheets.

                                         COMPUTATION OF CIGARETTE TAX REFUNDS
                                                                                               License No._______________________________
Number of Packages                            Brand                    Denomination of Stamps                           Value of Stamps

                                                                                                      Total        $
                                                                                               Less Discount

                                                                                         Net Refund Amount

SECTION THREE
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.
Signature                                                                     Title of Signing Officer

Printed Name of Signing Officer                                               Contact Phone Number                  Date

                                                        INSTRUCTIONS
SECTION ONE - TAXPAYER INFORMATION
Please provide the following information:
1a & b  . . . . . Taxpayer Name and Trade Name.
2a, b, c & d.  . Taxpayer’s mailing address.  All correspondence related to this claim will be mailed to this address.
3 . . . . . . . . . . The Federal Identification Number or Social Security number of the Business/Individual filing this claim.
4 . . . . . . . . . . Complete this line if the address on your tax returns is different than the mailing address.
5 . . . . . . . . . . Indicate the appropriate Tax Type.  Please submit a separate claim form for each tax type.  If tax is reported on an
                annual basis, complete a separate claim for each taxable year.
6 . . . . . . . . . . Enter the period covered by claim.
7 . . . . . . . . . . If applicable, enter the date the tax was paid to the vendor.
8 . . . . . . . . . . Enter the amount of the refund request.  This line must be completed.

SECTION TWO - EXPLANATION OF THE CLAIM
In accordance with N.J.A.C.. 18:2-5.8(g) “For the purpose of the Statute of Limitations on claims for refunds under N.J.S.A. 54:49-14
and N.J.S.A. 54A:9-8, and interest payments on late refunds under N.J.S.A. 54:49-15.1, the refund claim will not be deemed com-
plete until all the required information is submitted.”
The claim must clearly set forth in detail each ground upon which the claim is based.  Please provide sufficient documentation to
apprise the Division of the exact basis of the refund request.  Documentation includes such items as pertinent calculations, copies of
invoices or receipts and proof of tax paid.  If possible, please provide an electronic version (such as EXCEL) of any spreadsheets
submitted.
In accordance with N.J.A.C. 18:2-5.8(d)1 Refund Claim Procedures, if adjusting a quarterly return an Amended return must accom-
pany this claim.

SECTION THREE - SIGNATURES AND APPOINTMENT OF TAXPAYER REPRESENTATIVE
Whenever a claim is executed by an agent on behalf of the taxpayer, a signed  Appointment of Taxpayer Representative 
form (M-5008-R) must accompany the claim.

Where the taxpayer is a corporation, the claim will be signed with the corporate name, followed by the signature and title of the offi-
cer having the authority to sign for the corporation.  In the case of a partnership, either partner shall sign.

For contact purposes please print the name of the signing officer and provide a phone number.
For the following taxes:  S&U, ST-USE, UEZ, IST, S&U-EN AST-EN, TST, AC-LUX, .Hotel Occupancy Tax & Salem County send
the form to:
NJ Division of Taxation
Sales Tax Refund Section
PO Box 289
Trenton, NJ 08695-0289

For Cigarette Tax and Tobacco Products Tax:
NJ Division of Taxation
Excise Tax Branch
PO Box 187
Trenton, New Jersey 08695-0187

For Corporate Business Tax (CBT) Refund, send the form to:
NJ Division of Taxation
CBT Refund Section
PO Box 259
Trenton, NJ 08695-0259

All Other Business Refund Requests:
NJ Division of Taxation
Taxpayer Accounting Branch
PO Box 266
Trenton, NJ 08695-0266
To File For a Gross Income Tax (Individual) Refund, File an Amended Return With The
NJ Division of Revenue
Revenue Processing Center
PO Box 555
Trenton, NJ 08647-0555

All forms can be found on the Division’s web site:  www.state.nj.us/treasury/taxation