Name(s) as shown on Form NJ-1040
Your Social Security Number
15. Wages, salaries, tips, and other employee compensation (State wages from
Box 16 of enclosed W-2(s)) (See instructions) ....................................................... 15. , , .
16a. Taxable interest income (Enclose federal Schedule B if over $1,500)
(See instructions) .................................................................................................. 16a. , , .
16b. Tax-exempt interest income (Enclose Schedule)
(See instructions) Do not include on line 16a ............................................16b. , , .
17. Dividends ................................................................................................................. 17. , , .
18. Net prots from business (Schedule NJ-BUS-1, Part I, line 4)
(Enclose federal Schedule C) .................................................................................. 18. , , .
19. Net gains or income from disposition of property (Schedule NJ-DOP, line 4) ......... 19. , , .
20a. Pensions, Annuities, and IRA Withdrawals (See instructions).................................20a.
, , .
20b. Excludable Pensions, Annuities, and IRA Withdrawals ............................. 20b. , , .
21. Distributive Share of Partnership Income (Schedule NJ-BUS-1, Part II, line 4)
(Enclose Schedule NJK-1 or federal Schedule K-1) ............................................... 21. , , .
22. Net pro rata share of S Corporation Income (Schedule NJ-BUS-1, Part III, line 4)
(Enclose Schedule NJ-K-1 or federal Schedule K-1) .............................................. 22. , , .
23. Net gains or income from rents, royalties, patents, and copyrights
(Schedule NJ-BUS-1, Part IV, line 4) ...................................................................... 23. , , .
24. Net Gambling Winnings (See instructions) .............................................................. 24. , , .
25. Alimony and Separate Maintenance Payments received ........................................ 25. , , .
26. Other (Enclose documents) (See instructions) ........................................................ 26. , , .
27. Total Income (Add lines 15, 16a, 17 through 20a, and 21 through 26) ................... 27. , , .
28a. Retirement/Pension Exclusion (See instructions) ..................................... 28a. , .
28b. Other Retirement Income Exclusion (See Worksheet D and
instructions page 19) ................................................................................. 28b. , .
28c. Total Exclusion Amount (Add lines 28a and 28b) ..................................................................28c. , .
29. New Jersey Gross Income (Subtract line 28c from line 27)
(See instructions) .................................................................................................... 29. , , .
30. Exemption Amount (Enter amount from
line
13. Part-year residents see instr.) .......................... 30. , .
31. Medical Expenses (See Worksheet F and instructions page 22) ................................................. 31. , .
32. Alimony and Separate Maintenance Payments (See instructions) ...........................................32. , .
33. Qualied Conservation Contribution ..........................................................................................33. , .
34. Health Enterprise Zone Deduction ............................................................................................34. , .
35. Alternative Business Calculation Adjustment (Schedule NJ-BUS-2, line 11) ............................35. , .
36. Total Exemptions and Deductions (Add lines 30 through 35) ....................................................36. , .
37. Taxable Income (Subtract line 36 from line 29) ........................................................37. , , .
38a. Total Property Taxes (18% of Rent) Paid (See instructions page 23) ...38a. , , .
38b. Block . Lot . Qualier
38c. County/Municipality Code Fill in if you completed Worksheet G.
38d. Indicate your residency status during 2019 (ll in only one oval) ................ Homeowner Tenant Both
39. Property Tax Deduction (From Worksheet H) (See instructions) .......................................................39. ,
.
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