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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 S
ocial 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:
njtaxation.org
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.nj.gov
