Fillable Form 906: State of New Jersey Division of (The State of New Jersey)

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Form 906: State of New Jersey Division of (The State of New Jersey)

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State of New Jersey
Division of Taxation
Form 906
CLOSING AGREEMENT REQUEST
Enclosed packet includes:
1. A copy of the Closing Agreement statute.
2. A Closing Agreement Form 906 to complete.
3. Appointment of Taxpayer Representative, if applicable.
4. A Financial Statement of Debtor – Section I through Section V to be completed.
5. National Standard Expenses information to be used in the completion of
Section II of Financial Statement of Debtor.
NOTE: Copies of the Taxpayer’s last two years Individual IRS returns, and
Corporate returns, if applicable, are required to be submitted with Form 906.
Send completed required information to:
New Jersey Division of Taxation
Closing Agreem
ents
9
th
Floor
PO Box 245
Trenton, NJ 08695-0245
Closing Agreements
Authority
Unless otherwise expressly noted, all provisions of this chapter were adopted pursuant to authority of
N.J.S.A. 54:50-1 et seq. and were filed and became effective on January 27, 1978, as R. 1978 d. 29 Sec:
10 N.J.R. 41(a), N.J.R. 127(d).
Chapter Table of Contents
SUBCHAPTER 1 Closing Agreements
18:33-1.1 General provisions
18:33-1.2 Taxable periods
18:33-1.3 Finality; determination of fraud
18:33-1.4 Procedure with respect to closing agreements
18:33-1.5 Applicability and coverage; policy
18:33-1.6 Procedures
18:33-1.1 General provisions
(a) The Director of the Division of Taxation or any of his delegated representatives may enter into
a written agreement with any person relating to the liability of such person (or of the person or estate for
whom he acts) in respect to any State tax administered by the Director of the Division of Taxation for any
taxable period ending prior or subsequent to the date of such agreement. A closing agreement may be
entered into in any case in which there appears to be an advantage in having the case permanently and
conclusively closed, or if good and sufficient reasons are shown by the taxpayer for desiring a closing
agreement and it is determined by the director that the State of New Jersey will sustain no disadvantage
through consummation of such an agreement.
(b) A closing agreement may be executed even though under the agreement the taxpayer is not
liable for any tax for the period to which the agreement relates. There may be a series of closing
agreements relating to the tax liability for a single period.
18:33-1.2 Taxable periods
(a) Closing agreements with respect to taxable periods ended prior to the date of the agreement
may relate to the total tax liability of the taxpayer or to any or more separate items affecting the tax
liability of the taxpayer, as, for example, the amount of gross receipt, deduction items, other income
items, statutory deductions or exclusions, statutory additions to income, the year in which an item of
income is to be included in gross receipts or income, the year in which an item is to be deducted, or the
value of property on a specific date.
(b) Closing agreements with respect to taxable periods ending subsequent to the date of the
agreement may relate to one or more separate items affecting the tax liability of the taxpayer.
18:33-1.3 Finality; determination of fraud
(a) A closing agreement which is approved within such time as may be stated in such agreement,
or later agreed to, shall be final an conclusive, and, expect upon a showing of fraud or malfeasance, or
misrepresentation of a material fact.
1. The case shall not be reopened as to the matters agreed upon or the agreement
modified by an officer, employee, or agent of the State of New Jersey; and
2. In any suit, action, or proceeding, such agreement, or any determination, assessment,
collection, payment, abatement, refund, or credit made in accordance therewith, shall
not be annulled, modified, set aside, or disregarded. However, a closing agreement
with respect to a taxable period ending subsequent to the date of the agreement is
subject to any change in, or modification of, the law enacted subsequent to the date of
the agreement and made applicable to such taxable period, and each closing
agreement so recited.
(b) Execution and approval of closing agreement does not preclude an additional inspection of the
taxpayer’s records to determine whether fraud, malfeasance, or misrepresentation of material fact exists
as to execution of agreement.
18:33-1.4 Procedure with respect to closing agreements
(a) A request for a closing agreement which relates to a prior taxable period may be submitted at
any time before a case with respect to the tax liability involved is filed in the Division of Tax Appeals.
All closing agreements shall be executed on forms prescribed by the Director of the Division of Taxation.
(b) Any tax or deficiency in tax determined pursuant to a closing agreement shall be assessed and
collected, and any overpayment determined pursuant thereto shall be credited or refunded, in accordance
with the applicable provisions of law.
18:33-1.5 Applicability and coverage; policy
(a) The Director of the Division of Taxation or any Division of Taxation officer or employee
authorized in writing by the Director, can enter and approve written closing agreements with any person.
Such agreement can relate to the liability of such person (or the taxpayer represented by him), for any
State tax administered by the Division of Taxation for any taxable period. The agreement can cover
either the total liability of taxpayer or one or more of separate items affecting the liability, if it embraces a
tax period ending before the date of the agreement; or one or more separate items affecting tax liability.
There can be a series of agreements covering a single tax period.
(b) A closing agreement may be entered into when it appears advantageous to have the case
permanently closed; or where the taxpayer shows sufficient reason for desiring a closing agreement, and
there would be no disadvantage to the State of New Jersey in entering into it. Closing agreements can be
entered into, although under the agreement taxpayer is not liable for tax for the period covered.
18:33-1.6 Procedures
(a) A request to enter into a closing agreement is executed on prescribed forms and submitted,
processed and approved under prescribed procedure. If the proposed agreement relates to a prior taxable
period, it must be submitted before a case with respect to the tax liability is filed in the Division of Tax
Appeals or in any Division of the Superior Court of New Jersey or in any Federal Court.
(b) Where parties entered into a stipulation, on trial, or any matter regarding taxpayer’s liability,
and the action is dismissed with prejudice, taxpayer shall not be permitted to repudiate the agreement
because a closing agreement was not executed by the Director of the Division of Taxation.
(c) Taxpayer’s acceptance of a determination of additional tax under which an assessment of
additional tax was made and paid, does not preclude the Director from determining an additional
deficiency for the year.
(d) The Director of the Division of Taxation is not estopped from issuing a deficiency assessment.
Acceptance of a sum submitted with an amended return does not discharge a taxpayer from further
liability; a deficiency assessment is not a closing agreement.
Form M-5008-R (2-12) State of New Jersey Division of Taxation Page 1 of 2
APPOINTMENT OF TAXPAYER REPRESENTATIVE
(TYPE OR PRINT)
1. Taxpayer Information (if matter involves a joint income return, enter both names
if joint representation is requested).
Trusts: Enter the name and EIN of the trust, name and address of the trustee.
Estates: Enter the name and EIN of the estate, name and address of the executor or administrator.
Taxpayer’s Name Social Security number
Spouse’s/CU Partner’s Name Social Security number
Mailing Address
NJ Taxpayer ID number (if other than SS#)
City
State Zip
Name and Address of Trustee or Executor
Taxpayer is:
□ Individual (for an income or individual use tax return filed by that individual, or a joint income tax return
filed by the individual and his/her spouse/cu partner).
□ Corporation □ Partnership □ Sole Proprietorship
□ Estate □ Limited Liability Company □ Trust (other than a business trust)
□ Other: ___________
2. Representative Information (representative(s) must date and sign on page 2).
The taxpayer(s) named above hereby appoints the person(s) named below as his/her/their taxpayer
representative.
Name and Address Telephone Number:
Fax Number:
Representative ID:
Name and Address Telephone Number:
Fax Number:
Representative ID:
To represent the taxpayer(s) before the State for the following tax matter(s):
3. Tax Matters
□ All tax matters
□
Specific tax matters listed below:
Type of Tax (NJ Gross Income, Sales and Use, Corporate Business,
Employment, etc.)
Year(s) & Period(s)
4. Acts Authorized. The representative(s) is/are authorized to receive and inspect confidential tax
records and is/are granted full power to act with respect to the tax matters described in section 3 above, and to
do and perform all such acts as I could do or perform. The authority does not include the power to endorse a
refund check.
_________________________________ __________________ __________________________
Taxpayer Signature Date Title (if applicable)
_________________________________ __________________ __________________________
Taxpayer Signature Date Title (if applicable)
Form M-5008—R (2-12) Page 2 of 2
Taxpayer Name: ___________________________________ SS # ____________________
5. Notices and Communications. Original notices and other written communications will be sent to
you and a copy (other than automated computer notices), to the first representative listed in Section 2 unless
you check one or more of the boxes below.
□ I do not want any notices or communications sent to my representative(s).
□ The second representative listed in section 2 should also receive a copy of notices
and/or communications (other than automated computer notices).
6. Retention/Revocation of Prior Appointment(s) or Power(s). The filing of this
Appointment of Taxpayer Representative automatically revokes all earlier Appointment(s) of Taxpayer
Representative and/or Power(s) of Attorney on file with the Division of Taxation for the same tax matters and
years or periods covered by this document unless the box below is checked.
□ Check here if you do not want to revoke any prior Appointment(s) of Taxpayer Representative
or Power(s) of Attorney. Attach copies of previous Appointment or Power that you do not want to
revoke.
7. Signature of Taxpayer(s). If a tax matter concerns a joint return, both primary and
spouse/cu partner must sign below if joint representation is requested. If signed by a corporate officer,
partner, guardian, tax matters partner, executor, administrator, or trustee on behalf of the taxpayer, I
certify that I have the authority to execute this form on behalf of the taxpayer(s).
THIS APPOINTMENT OF TAXPAYER REPRESENTATIVE IS VOID IF NOT SIGNED
AND DATED.
I/We declare under penalty of law that I/We have examined this document and that all information
included is true and correct to the best of my/our knowledge, information and belief.
_________________________________ __________________ __________________________
Taxpayer Signature Date Title (if applicable)
_________________________________
Print Name
_________________________________ __________________ __________________________
Taxpayer Signature Date Title (if applicable)
_________________________________
Print Name
8. Acceptance of Representation and Sample Signature.
I/We hereby accept appointment as representative(s) for taxpayer(s) who has/have executed this
Appointment of Taxpayer Representative.
_________________________________ __________________ __________________________
Representative Signature Date Title (if applicable)
_________________________________
Print Name
_________________________________ __________________ __________________________
Representative Signature Date Title (if applicable)
_________________________________
Print Name
Page 1 of 2
(2--12)
STATE OF NEW JERSEY – DIVISION OF TAXATION
INSTRUCTIONS FOR FORM M-5008-R
APPOINTMENT OF TAXPAYER REPRESENTATIVE
Purposes of Form. Form M-5008-R, Appointment of Taxpayer Representative, may be used to designate
an individual(s) named as representative(s) and grants the representative(s) the authority to obligate, bind or
appear on your behalf with respect to the tax matters listed in Section 3 of the Appointment of Taxpayer
Representative Form. This form may be used for all New Jersey taxes except those pertaining to Property
Administration. (Refer to Form M-5041).
The representative(s) may be authorized to receive your confidential tax information. Unless otherwise
indicated, the representative(s) may also perform any and all acts that you can perform, including
consenting to extend the time to assess tax, or executing consents that agree to a tax adjustment.
Representatives may not sign returns or delegate authority unless specifically authorized on the
Appointment of Taxpayer Representative.
Note: Authorizing someone to represent you before the Division by an Appointment of Taxpayer
Representative does not relieve you of your tax responsibilities or obligations. It primarily allows
for representation by others in most matters concerning tax administration, investigations,
examinations/audits and other forms of taxpayer conferences. Since the obligation for tax
liabilities lies with the taxpayer, the authority granted to a representative may not extend through
certain aspects of the collection process to include, but not limited to judgments, levies, liens and
seizures. In those instances the Division may require telephone communication, direct contact
and/or interaction with the taxpayer. To the extent possible, however, the Division will make a
reasonable effort to honor authorized representation. Additionally, to protect the interests of the
taxpayer, the Division will contact the taxpayer directly when it has documentable instances of
unreasonable delays, incompetence or other forms of malfeasance of the appointed taxpayer
representative.
Form M-5008-R, Appointment of Taxpayer Representative, will not be required when an individual
appears with the taxpayer or with an individual who is authorized to act on behalf of taxpayer. For
example, Form M-5008-R is not required if an individual appears on behalf of a corporate taxpayer with an
authorized corporate officer. The Form is also not required if a trustee, receiver or attorney has been
appointed by a court having jurisdiction over a debtor. In addition, the Form is not required if an
individual merely furnishes tax information or prepares a report or return for the taxpayer.
Fiduciaries. A fiduciary (such as a trustee, receiver, or guardian) stands in the position of a taxpayer and
acts as the taxpayer. Therefore, a fiduciary does not act as a representative and should not file an
Appointment of Taxpayer Representative. However, if a fiduciary wishes to authorize an individual to
represent or act on behalf of the entity, an Appointment of Taxpayer Representative must be filed and
signed by the fiduciary.
Who Can Execute the Appointment of Taxpayer Representative
?
- Any individual, if the request pertains to a personal income or individual use tax return filed by that
individual (or by an individual and his or her spouse/cu partner if the request pertains to a joint income tax
return and joint representation is requested). If joint representation is not requested each taxpayer must file
his or her own separate Appointment of Taxpayer Representative.
- A member of a Limited Liability Company (LLC), if the taxpayer is an LLC and there is no manager;
- A manager of the LLC;
- A sole proprietor;
- A general partner of a partnership or limited partnership;
- The administrator or executor of an estate;
- The trustee of a trust.
- If the taxpayer is a corporation, a principal officer or corporate officer who has legal authority to bind the
corporation; any person who is designated by the board of directors or other governing body of the
corporation; any officer or employee of the corporation upon written request signed by a principal officer
of the corporation and attested by the secretary or other officer of the corporation; or any other person who
is authorized to receive or inspect the corporation’s return or return information under I.R.C.
§6103(e)(1)(D).
Form M-5008-R Instructions (2-12) Page 2 of 2
Tax Matters
The Appointment of Taxpayer Representative will apply to all tax types and taxable years or privilege
periods unless the taxpayer(s) designates otherwise.
Retention/Revocation of Prior Powers of Attorney and/or Appointment of Taxpayer Representative
You may not partially revoke a previously filed Appointment of Taxpayer Representative or Power of
Attorney. If a previously filed Appointment of Taxpayer Representative or Power of Attorney has more
than one representative and you do not want to retain all the representatives on the previously filed Form,
you must execute a new Appointment of Taxpayer Representative indicating the representative(s) you want
to retain.
Taxpayer’s Signature
Form M-5008-R must be signed by the taxpayer or by an individual who is authorized to execute the
Appointment of Taxpayer Representative on behalf of the taxpayer. The taxpayer or his/her or its
representative(s) may be required to provide identification and evidence of authority to sign this
Appointment of Taxpayer Representative.
Individuals. You must sign and date Form M-5008-R. If a joint gross income tax return has been filed and
both husband and wife/both cu partners will be represented by the same individual(s), both must sign Form
M-5008-R unless one spouse/cu partner authorizes the other, in writing, to sign for both. In that case,
attach a copy of the authorization. If, however, a joint income tax return has been filed and husband and
wife/cu partners will be represented by different individuals, each taxpayer must execute his or her own
Appointment of Taxpayer Representative on a separate Form M-5008-R.
Corporations. The president, vice-president, treasurer, assistant treasurer, or any other officer of the
corporation having authority to bind the corporation must sign Form M-5008-R.
Partnerships. All partners must sign Form M-5008-R, or if the Appointment of Taxpayer Representative is
executed on behalf of the partnership only, it must be signed by a partner authorized to act for the
partnership. A partner is authorized to act in the name of the partnership if, under state law, the partner has
authority to bind the partnership.
Limited Liability Companies. A member or manager must sign Form M-5008-R, or, if the Appointment of
Taxpayer Representative is executed on behalf of the Limited Liability Company (LLC) only, it must be
signed by any member or manager duly authorized to act for the LLC, who must certify that he or she has
such authority.
Fiduciaries. In matters involving fiduciaries under agreements, declarations or appointments, Form M-
5008-R must be signed by all of the fiduciaries, unless proof is furnished that fewer than all fiduciaries
have the authority to act in the matter under consideration. Include evidence of the authority of the
fiduciaries to act when filing Form M-5008-R.
Estates. The administrator or executor of an estate may sign on behalf of an estate.
Trusts. The trustee of a trust may execute the Appointment of Taxpayer Representative.
Others. Form M-5008-R must be signed by the taxpayer or by an individual having the authority to act in
the name of the taxpayer.
The signature of an individual(s) that is/are not the taxpayer(s) identified in Section 1 certifies that he or
she has or they have the authority to act for the taxpayer(s). This applies to a corporate officer, partner,
guardian, tax matters partner, executor, administrator, or trustee acting on behalf of the taxpayer(s).
You must indicate the date of execution on Form M-5008-R.
New Jersey Treasury Department – Division of Taxation
CLOSING AGREEMENT AS TO FINAL DETERMINATION
COVERING SPECIFIC TAX MATTERS
NJ Form 906
A request for a Closing Agreement to be made between
________________________________________________ ________________
(Name of Taxpayer) (Social Security #)
______________________________________________________________________
(Address)
________________________________________________ ________________
(and/or Corporation) (Federal ID #)
(If Corporation please provide a current financial statement)
______________________________________________________________________
(Address)
for ____________________________________________________________________
(Type of Tax or Taxes and Outstanding Years/Periods)
and the Director of the Division of Taxation.
Please state below the reasons why the taxpayer feels they should not have to pay the total
outstanding tax liabilities due the Division of Taxation.
(If additional space is required you may attach an additional sheet)
Amount Offered as Payment in Full: $_________________
How will payment be made? ________________________
Source of Funds for Offer: __________________________
______________________________________ _______________
Signature of Taxpayer/Officer Date
State of New Jersey Division of Taxation
Financial Statement of Debtor
Section I – Employment Data
1. __________________________________________ 2. ______________ 3. _________________
Name (Debtor) Birth Date Social Security #
4. ______________________________________________________________ ___________________
Home Address Phone Number
5. __________________________________________ 6. ______________ 7. _________________
Name (Spouse) Birth Date Social Security #
(Provide address if different from yours)
DEBTOR EMPLOYMENT DATA
8. Occupation: ________________________ 9. How Long in Present Employment? ___________
10. Present Employer’s Name: _______________________________________________________
Address: ________________________________________ Phone Number________________
11. Present Monthly Income Total: $_______________
(Provide breakdown on line below)
Salary or Wages $__________ Commissions $_________ Other (State Source) $_________
12. Other Employment – Within the last three years:
Employer’s Name Address Phone Number Employment Dates
________________ _____________________________ _____________ ________________
________________ _____________________________ _____________ ________________
________________ _____________________________ _____________ ________________
SPOUSE’S EMPLOYMENT DATA
13. Occupation: ________________________ 14. How Long in Present Employment? ___________
15. Present Employer’s Name: _______________________________________________________
Address: ________________________________________ Phone Number________________
16. Present Monthly Income Total: $_______________
(Provide breakdown on line below)
Salary or Wages $__________ Commissions $_________ Other (State Source) $_________
17. Other Employment – Within the last three years:
Employer’s Name Address Phone Number Employment Dates
________________ _____________________________ _____________ _______________
________________ _____________________________ _____________ _______________
________________ _____________________________ _____________ _______________
DEPENDENTS
18. Total Number: _______
Relationship __________ Age ___ Relationship __________ Age ___ Relationship _________ Age ___
19.Total Monthly Income of Dependents (except spouse): $_______________
Section II – Financial Data
20. For what period did you last file a Federal tax return? _________________________
21. For what period did you last file a New Jersey Income tax return? _______________
22. Amount of Gross Income reported on last Federal tax return filed? $_____________
Monthly
Income and Expense Analysis
Total Income
Gross
Necessary Living Expenses
Claimed
23. Wages/Salaries (Taxpayer) $ 34. National Standard Expenses (1)
$
24. Wages/Salaries (Spouse)
35. Rent/ Mortgage
25. Interest / Dividends
36. Utilities
26. Net Business Income
37. Health Care
27. Rental Income
38. Taxes (Income) - Federal
28. Pension (Taxpayer)
39. Taxes (Income) – State
29. Pension (Spouse)
40. Property Taxes
(If not included with mortgage)
30. Child Support
41. Court Ordered Payments
31. Alimony
42. Child/Dependent Care
32. Other Income (Specify)
43. Other Expenses (Specify)
33. Total Income
$
44. Total Expenses
$
(1) Select value from National Standard Expenses Table on last page of this application
Section III – Assets and Liabilities
Assets
45. Cash $ _____________
46. Checking Account _____________
47. Savings Account _____________
48. Stocks, Bonds & Other Securities _____________
49. Cash or Loan Value of Insurance _____________
50. Motor Vehicles (Model and Year)
a. Owned Vehicles
1. ____________________________ _____________
2. ____________________________ _____________
3. ____________________________ _____________
b. Leased Vehicles
1. ____________________________ _____________
2. ____________________________ _____________
3. ____________________________ _____________
51. Debts Owed to You _____________
52. Household Furniture and Goods _____________
53. Items Used in Trade or Business _____________
54. Real Estate
1. __________________________________ _____________
2. __________________________________ _____________
3. __________________________________ _____________
4. __________________________________ _____________
55. Any Other Assets - Specify
1. __________________________________ _____________
2. __________________________________ _____________
3. __________________________________ _____________
4. __________________________________ _____________
Total Assets $ _____________
Section III – Assets and Liabilities Continued
Liabilities
56. Bills Owed (Doctors, Lawyers, etc.)
1. __________________________________ $_____________
2. __________________________________ _____________
3. __________________________________ _____________
57. Installment Debt (Car, Credit Card, etc.)
1. __________________________________ _____________
2. __________________________________ _____________
3. __________________________________ _____________
4. __________________________________ _____________
5. __________________________________ _____________
58. Federal Taxes Owed _____________
Has Federal lien been filed? _________
(If yes please supply copy)
59. State Taxes Owed _____________
60. Real Estate Mortgages (2)
1. __________________________________ _____________
2. __________________________________ _____________
3. __________________________________ _____________
61. Loans Payable (To Banks, Finance Co., etc.) (2)
1. __________________________________ _____________
2. __________________________________ _____________
3. __________________________________ _____________
62. Judgments Owed (Other Than Federal or State)
(Please supply copy)
1. __________________________________ _____________
2. __________________________________ _____________
3. __________________________________ _____________
63. Other Debts (Itemize)
1. __________________________________ _____________
2. __________________________________ _____________
3. __________________________________ _____________
Total Liabilities $ _____________
(2) Note: Please include your current statement from lender with monthly payment amount and
current balance due.
Section IV – General Financial Information
64. Real Property (Brief description and type of ownership)
Physical Address Date Acquired Cost
______________________________________ _______________ ___________
______________________________________ _______________ ___________
______________________________________ _______________ ___________
______________________________________ _______________ ___________
65. Bank Accounts
(Include Savings and Loans, Credit Unions, IRAs & Retirement Plans, Certificate of Deposit, etc.)
Name of Institution Address Type Acct # Balance
________________ _________________ ___________ ___________ ___________
________________ _________________ ___________ ___________ ___________
________________ _________________ ___________ ___________ ___________
Total $ ___________
66. Securities (Stocks, bonds, mutual funds, money market funds, government securities, etc.)
Kind Quantity Owner of Record Current Value
_______________________ ___________ ________________ ________________
_______________________ ___________ ________________ ________________
_______________________ ___________ ________________ ________________
_______________________ ___________ ________________ ________________
Total $________________
67. Charge Cards and lines of credit from banks, credit unions and savings and loans
Financial Credit Amount Monthly
Type of Account or Card Institution Limit Owed Payment
______________________ ________________ ______ __________ __________
______________________ ________________ ______ __________ __________
______________________ ________________ ______ __________ __________
______________________ ________________ ______ __________ __________
______________________ ________________ ______ __________ __________
Total $__________
68. Life Insurance
Type Face Available
Name of Company Policy Number Whole/Term Amount Loan Value
________________ ________________ __________ ___________ ____________
________________ ________________ __________ ___________ ____________
________________ ________________ __________ ___________ ____________
Total $____________
Section V – General Information
69. Are you a party in any lawsuit now pending? ____ Yes ____No
If yes please explain: _____________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
70. Are you a trustee, executor or administrator? ____ Yes ____No
If yes please explain: _____________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
71. Is anyone holding any monies on your behalf? ____ Yes ____No
If yes please explain: _____________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
72. Is there any likelihood you would receive an inheritance? ____ Yes ____No
If yes please explain: _____________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
73. Do you receive or under any circumstances expect to receive benefits from an established
trust from a claim for compensation or damages from a contingent or future interest in
property of any kind? ____ Yes ____No
If yes please explain: _____________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
With knowledge of the penalties for false statements provided by 2C:21-4(b) ($7,500 fine and /or
3-5 years imprisonment) and with the knowledge that this financial statement is submitted by me to
affect action by the Division of Taxation, I certify that I believe the above statements are true and
that it is a complete statement of all my income and assets, real and personal, whether held in my
name or by any other.
___________________ _____________________________________
Date Signature
Revised 08/2004
National Standards: Food, Clothing and Other Items
Disclaimer: IRS Collection Financial Standards are intended for use in calculating repayment of
delinquent taxes. These Standards are effective on April 1, 2013 for purposes of federal tax
administration only. Expense information for use in bankruptcy calculations can be found on the website
for the U.S. Trustee Program.
Download the national standards for food, clothing and other items in PDF format for printing. Please note
that the standard amounts change, so if you elect to print them, check back periodically to assure you
have the latest version.
National Standards have been established for five necessary expenses: food, housekeeping supplies,
apparel and services, personal care products and services, and miscellaneous.
The standards are derived from the Bureau of Labor Statistics (BLS) Consumer Expenditure Survey
(CES) and defined as follows:
Food includes food at home and food away from home. Food at home refers to the total expenditures for
food from grocery stores or other food stores. It excludes the purchase of nonfood items. Food away from
home includes all meals and snacks, including tips, at fast-food, take-out, delivery and full-service
restaurants, etc.
Housekeeping supplies includes laundry and cleaning supplies, stationery supplies, postage, delivery
services, miscellaneous household products, and lawn and garden supplies.
Apparel and services includes clothing, footwear, material, patterns and notions for making clothes,
alterations and repairs, clothing rental, clothing storage, dry cleaning and sent-out laundry, watches,
jewelry and repairs to watches and jewelry.
Personal care products and services includes products for the hair, oral hygiene products, shaving needs,
cosmetics and bath products, electric personal care appliances, and other personal care products.
The miscellaneous allowance is for expenses taxpayers may incur that are not included in any other
allowable living expense items, or for any portion of expenses that exceed the Collection Financial
Standards and are not allowed under a deviation. Taxpayers can use the miscellaneous allowance to
pay for expenses that exceed the standards, or for other expenses such as credit card payments, bank
fees and charges, reading material and school supplies.
Taxpayers are allowed the total National Standards amount monthly for their family size, without
questioning the amounts they actually spend. If the amount claimed is more than the total allowed by the
National Standards for food, housekeeping supplies, apparel and services, and personal care products
and services, the taxpayer must provide documentation to substantiate those expenses are necessary
living expenses. Deviations from the standard amount are not allowed for miscellaneous expenses.
Generally, the total number of persons allowed for National Standards should be the same as those
allowed as exemptions on the taxpayer’s most recent year income tax return.
Expense One Person Two Persons Three Persons Four Persons
Food $315 $556 $645 $777
Housekeeping supplies $30 $66 $65 $74
Apparel & services $88 $162 $209 $244
Personal care products & services $34 $60 $64 $70
Miscellaneous $116 $209 $251 $300
Expense One Person Two Persons Three Persons Four Persons
Total $583 $1,053 $1,234 $1,465
More than four persons Additional Persons Amount
For each additional person, add to four-person total allowance: $281
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Form 906: State of New Jersey Division of (The State of New Jersey)

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Completed 21 July 2020

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