State of New Jersey 
                                                         Division of Taxation 
                                                      Inheritance and Estate Tax 
                                                      Protective Claim for Refund 
                             Pursuant to N.J.A.C. 18:26-3A.12(e) and N.J.A.C. 18:26-10.12(d) 
                                                                        
Name of Decedent __________________________________________________________________________________________ 
                         (Last)                         (First)                                      (MI)
 
Decedent’s S.S. No. ________________ Date of Death (mm/dd/yy) ________________ County of Residence ________________ 
 
Mailing Address for All Correspondence:                  
                                     Name ______________________________ Phone (_____) _______________
                                     Street _______________________________________________ 
                                     City ______________________ State_____________ Zip______________
 
Protective refund claims must be made using this form and be based on reasonably anticipated events. 
 
All protective refund claims must be filed within three years from the date of payment.The date of payment is defined as the date the payment 
is actually received by the Division. It is not the date on which the tax return is filed, the date the Notice of Assessment is issued or the date on 
which the audit is completed and/or the file closed.  
 
Inheritance tax only - A protective refund claim may also be filed within three years from the date of a final determination of a court of 
competent jurisdiction which establishes that the decedent had no legal or equitable interest in the property on which the tax was assessed. The 
determination must be made within 20 years of the decedent’s death. 
 
The Director must be notified of the actual refund claimed within 90 days after the occurrence of the anticipated event. 
 
For purpose of the Statute of Limitations on claims for refunds under N.J.S.A. 54:35-10 and N.J.S.A. 54:38-3, a protective refund claim will not 
be deemed to be complete until this form is fully completed. The estimated amount of the refund and the ground(s) upon which the claim is 
based must be set forth. 
 
    Inheritance Tax                  Estate Tax
  
    Estimated Amount of Refund Claim:                   $______________________ 
 
    Detailed Explanation of Refund Claim:                
 
This completed form must be mailed to:  New Jersey Division of Taxation 
                                           Inheritance and Estate Tax
                                           P.O. Box 249
                                           Trenton, New Jersey 08695-0249
 
I declare under the penalties of perjury that this claim has been examined by me and to the best of my knowledge and belief is 
true and correct. 
 
Signature: _______________________________ Executor                         Administrator 
 
Print Name: _____________________________  Phone Number _____________________ Date: ____________________ 
 
For Division Use Only:  Approved                        Disapproved            Date __________________ 
 

 Instructions:
 
 1. Fully complete this form. 
 
 2. Explain the contingencies and issues affecting the refund claim. Set forth anticipated decreases in the value of the 
    assets and increases in the value of the deductions on which the tax was originally calculated.  
 
 3. Provide an estimate of the amount of the tax overpayment.