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A-3128                                                      New Jersey
 (5-21)                                                     Division of Taxation
                                                         Claim for Refund of the                                For Official Use Only
                                            Estimated Gross Income Tax Payment
                                                                                                             Claim No.
                                            for the Sale of New Jersey Real Estate
To qualify for this refund, taxpayers must:
1)  Attach a copy of the GIT/REP-3 form if they erroneously paid estimated tax and qualify for one of the exemptions listed on the 
 GIT/REP-3; or
2)  Attach documentation that they overpaid estimated tax based on calculated gain on sale of property.

                                                         Print or Type This Form.
Social Security Number(s)

Name of Taxpayer(s):       Last                                  First                                      Middle

Current Address of Taxpayer(s):            Number and Street

City                                                                  State                            ZIP Code

Address of Property Sold:                  Number and Street

City                                                                  State                            ZIP Code

Property Use:                   Personal                     Vacation                          Rental                   Business

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, Seller’s Residency Certification/
Exemption, enter $0. A completed copy of the GIT/REP-3 Form indicating your exemption status must be attached.

                                                                                              Tax Rate Table
Date Sold:                      Sale Price:              $            Net Gain   But Not                               Estimated
                                                                       Over           Over    Multiply Net Gain By     Tax Liability
Date Purchased:                 Federal Adjusted Basis:  $                  $0        $20,000 x                 0.014
Percentage Owned:               Net Gain/Loss:           $             $20,000        $35,000 x                 0.0175
                                (If Net Loss - enter $0.)
                                                                       $35,000        $40,000 x                 0.035
Estimated Gross Income Tax Payment submitted:            $             $40,000        $75,000 x                 0.05525
Applicable Tax Year:                                                   $75,000   $500,000     x                 0.0637
** Estimated Tax Liability Due:                          $            $500,000   $1,000,000   x                 0.0897
                                                                      $1,000,000 and over     x                 0.1075 

Amount of Refund Claim:                                  $ 

Additional Information may be requested in order to complete your claim for a refund. The Division must have a record of receiving 
the “Estimated Gross Income Tax Payment submitted” before your claim can be processed.

**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.

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Appointment of Taxpayer Representative
If this form is being prepared by anyone other than the taxpayer(s), an Appointment of Taxpayer Representative must be included.

Under penalties of perjury, I declare that I have examined this claim, and to the best of my knowledge and belief, it is true, correct, and 
complete. Declaration of preparer is based on all information of which preparer has any knowledge. 

Signature of Claimant(s)/Preparer:                                                    Date:  

If the preparer of this claim has been paid, indicate the firm’s name, address, the firm’s federal EIN and the preparer’s Social Security 
number, federal identification number, or federal preparer tax identification number.

Firm’s Name:                                                                          Preparer’s SS # or Federal PTIN:

Firm’s Address:                                                                       Preparer’s Federal EIN:

                Mail this claim form along with the Settlement Statement (HUD-1) or Closing Disclosure form to:
                                      Division of Taxation
                                      Taxpayer Accounting Branch
                                      P.O. Box 046
                                      Trenton, N.J. 08646-0046

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Instructions for Form A-3128

Note: Use this form to claim a refund. Do not use form GIT/REP-4 to claim a refund.
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 N.J.S.A. 54A:8-8 through N.J.S.A. 54A:8-10. This form can only be filed with the Division of
Taxation after the recording of the deed with the county clerk.
2. Separate forms must be used for each taxpayer, except for husband and wife who 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, percentage owned, and net gain/loss of the property
sold.
7. Calculate and enter the estimated tax liability using the table provided on the form. 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 indicating your exemption status must be attached.

Example:
Tax Rate Table
Net Gain But Not Estimated
Date Sold: 2/4/20 Sale Price: $315,000 Over Over Multiply Net Gain By Tax Liability
$0 $20,000 x 0.014
Date Purchased: 9/21/16 Federal Adjusted Basis: $279,000
$20,000 $35,000 x 0.0175
Percentage Owned: 100% Net Gain/Loss: $36,000
(If Net Loss, enter $0.) $35,000 $40,000 x $36,000 0.035 $1,260
Estimated Gross Income Tax Payment submitted: $6,000
$40,000 $75,000 x 0.05525
** Estimated Tax Liability Due: $1,260
$75,000 $500,000 x 0.0637
Amount of Refund Claim: $4,740
$500,000 $1,000,000 x 0.0897
$1,000,000 and over x 0.1075

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 the 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 along with the Settlement Statement (HUD-1) or Closing Disclosure form 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 Division of Taxation receives a properly
completed claim form along with the required documentation.

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