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 pages 19-20) .......................................................................... 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) ............................................................... 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. Organ/Bone Marrow Donation Deduction (See instructions) ....................................................36. , .
37. Total Exemptions and Deductions (Add lines 30 through 36) ....................................................37. , .
38. Taxable Income (Subtract line 37 from line 29) ........................................................38. , , .
39a. Total Property Taxes (18% of Rent) Paid (See instructions page 23) ...39a. , , .
39b. Block . Lot . Qualier
39c. County/Municipality Code Fill in if you completed Worksheet G.
39d. Indicate your residency status during 2020 (ll in only one oval) ................ Homeowner Tenant Both
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