•
•
2021 NJ- I 040
New Jersey Resident Income Tax Return
For Pri"acy Act otification. Sec lns1ructions
J- 1040
N900
2021
Page 1
0 40M P01210
Last
Your Social Security Number (required)
Spouse's/CU Partner' s SS
ame, First I ame, Initial (Joint FileBcnttt fir.U ni:unc and middle ini1ialofcach.
&itcr SpOusc::vcu partner·s last nome ONLY Irdifferent.)
STINGLEY DENARA V
554318851
(iffiling joimly)
Home Address (Number and Street, including apartmem number)
County/Municipal ity Code (See Table page 50)
336 PAVONIA AVE APT 1
State
City, Town, Post omce
NJ
NEW JERSEY CITY
Driver' s License
X
umber (Voluntary) (See in !ructions)
Your address has changed.
X
X
X
Death certificate is enclosed.
Do not want a paper fonm next year.
o
D
I authorize the Division of Taxation to discuss my return and enclosures with my preparer.
NJ- I 040-0 is enc losed.
y
r
e
l
G ubernatoria l Elections f und
i
F
a
M
t
Federal extension filed.
The address above is a foreign address.
n
I
il
ZIP Code
07302
o
N
p
o
C
ote: This does not reduce your refund or increase your balance due.
Do you want to designate $1 to the Gubernatorial Elections Fund?
You
Yes
lfjoinl return, doe your spouse want to designate$! ?
Spouse/CU Partner
Yes
X
0
0
Direct Deposit In fo rm ation
dd I. Direct deposit indicator ( I for direct deposit, 4 for no direct deposit)
ddl.
dd2. Account type (C for checking, S for savings)
dd2.
dd3. Fill in the chcckbox if the direct deposit is going lo an account outside the United tales
dd3 .
dd4. Routing number
dd4.
dd5. Accoum number
dd5.
•
1
C
321171184
42024192884
•
•
Name(s) as shown on Fonn
•
J-1040
STINGLEY DENARA V
J- 1040
Your Social Security Number
2021
Page 2
554318851
N900
040MP02210
Part-year residems, provide months/days you were a
21
From:
To:
ew Jersey resident during 202 1:
Fiscal year fi lers only:
21
Enter month of your year end
2021
Fil ing S tatus
Fill in only one.
I.
X
ingle
2.
Married/C
Couple, filingjoim return
3.
Ma rried/C
Partner, filing separate return
4.
Head of Household
5.
Quali fy ing Widow(er)/Surviving CU Partner
Enter spouse's/CU partner's
Indicate the year of your spouse's/CU partner's death:
2019
N
a
Exemptions
Fill in 1hc ovals Lha1 apply. You mus1 enter a total in the boxes 10 the right and complete the calculation.
6.
Regu lar
7.
8.
X
elf
pouse/CU Partner
Senior 65+ (Born in 1956 or earl ier)
Self
Spouse/CU Partne r
Blind/Disabled
Self
Spou e/C
9.
Veteran
Self
Spouse/CU Partne r
10.
Quali fied Dependent Children
I I.
Other Dependents
12.
Dependents Auending Colleges (See instructions)
13.
Total Exem ption Amount (Add totals from the li nes at 6 through 12)
14.
Dependent Information. Provide the following informat ion for each dependent.
Last
ame, First
b.
c,
d.
r
e
il
M
t
Domestic Partner
Partner
y
ame, Middle Initial
a.
n
I
il
2020
o
D
o
N
Social Security
umber
1
0
0
0
x$1,000=
X
X
$ ),000
=
J,000 =
=
=
X
$6,000
X
1,500
X
$) ,500 =
x$ 1,000 =
13.
Birth Year
1000
0
0
0
0
0
0
1000
o Health Insurance
p
o
C
F
•
•
•
Name(s) as shown on Fonn
•
J-1040
STINGLEY DENARA V
J-1040
Your Social Security Number
2021
N900
554318851
Page 3
040MP03210
15.
Wages, salaries, tips, and other employee compensation (State wages from Box 16 of enclosed W-2(s)) (See instructions)
16a.
Taxable interest income (Enclose federal Schedule B if over $1,500) (Sec instructions)
16a.
16b. Tax-exempt interest income (Enclose Schedule) (See instructions) Do not include on line 16a
16b.
17.
Dividends
18.
Net profits from business (Schedule NJ-BUS- I, Part I, line 4) (Enclose federal Schedule C)
19.
20a.
15.
17.
et gains or income from disposition of property (Schedule
18.
J-DOP, line 4)
19.
Taxable pensions, annuities, and IRA distributions/withdrawals (See instructions)
20a.
20b. Excludable pension, annuity, and IRA distributions/withdrawals
21.
Distributive Share of Partnership Income (Schedule
22.
Net pro rata share of S Corporation Income (Schedule
23.
24.
20b.
J-BUS-1, Part I I, line 4) ( nclose Schedule
et gains or income from rems, royalties, patents, and copyrights ( chedule
21.
22.
J-B S-1, Part IV, line 4)
23.
a
et Gambling Winnings (See instructions)
Alimony and Separate Maintenance Payments received
26.
Other (Enclose documents) (See instructions)
27.
Total Income (Add lines 15, I 6a, 17 through 20a, and 21 tluough 26)
28a.
Pension/Retirement Exclusion (See instn1ctions)
28b.
Unclaimed Pension Exclusion/Special Exclusion (See Worksheet D and instructions pages 19-20)
28c.
Total Exclusion Amount (Add lines 28a and 28b)
ew Jersey Gross Income (Subtract line 28c from line 27) (See insm1ctions)
30.
Exemption Amount (Emcr amount from line 13. Part-year residents see instr.)
31.
Medical Expenses (See Worksheet F and instructions)
32.
Alimony and Separate Maintenance Payments (See instructions)
33.
Qualified Conservation Contribution
34.
Health Enterprise Zone Deduction
35.
Alternative Business Calculation Adjustment (Schedule
36.
Organ/Bone Marrow Donation Deduction (Sec instructions)
y
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Total Exemptions and Deductions (Add lines 30 through 36)
Taxable Income (Subtract line 37 from line 29)
39a.
Total Property Taxes ( 18% of Rent) Paid (Sec instructions page 23)
39b.
Block
39b.
Lot
24.
25.
26.
27.
67509
28a.
28b.
28c.
29.
30.
0
67509
1000
31.
32.
33.
34.
35.
op
37.
36.
37.
38.
C
r
1000
66509
39a.
li e
F
o
D
M
t
J-8 S-2, line 11)
38.
39b. Qualifier
n
I
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JK-1 or federal Schedule K-1)
J-BUS-1, Part Ill, line 4) (Enclose Schedule NJ-K-1 or federal Schedule K-1)
25.
29.
67509
Fill in if you completed Worksheet G
39c.
County/Municipality Code
39d.
Indicate your residency status during 2021 (fill in only one)
40.
Property Tax Deduction (From Worksheet 1-i) (See instructions)
40.
41.
New Jersey Taxable Income (Subtract line 40 from line 38)
41.
42.
Tax on Amount on line 41 (Tax Table page 52)
42.
43.
Credit For Income Taxes Paid to Other Jurisdictions (Enclose chedule
l= lomeowner
J-COJ) ( cc instructions)
Tenant
Both
66509
2183
43.
Enter Code
44.
Balance of Tax (Subtract line 43 from I inc 42)
44.
45.
Sheltered Workshop Tax Credit
45.
46.
Gold Star Family Counseling Credit (See instructions)
46.
47.
Credit for Employer of Organ/Bone Marrow
47.
48.
Total Credits (Add lines 45 through 47)
48.
49.
Balance of Tax After Credits (Subtract line 48 from line 44) If zero or less, make no entry
49.
50.
Use Tax Due on Internet, Mail-Order, or Other Out-of-State Purchases (See instructions) lfno Use Tax, enter 0
so.
51.
Interest on Underpayment of Estimated Tax
SI.
•
52.
Fill in if Fonn
onor (See instructions)
J-2210 is enclosed
Shared Responsibility Payment (See instructions)
REQ
IREO
nclosc Schedule HCC and fill in
52.
2183
0
2183
•
•
Name(s) as shown on Fonn
•
J- 1040
STINGLEY DENARA V
J-1040
Your Socia l Securi ty Number
2021
Page 4
554318851
N900
040MP04210
53 .
To1al Tax Due (Add lines 49 th rough 52)
53.
54.
Tota l J Income Tax With held (Encl ose Form s W-2 and 1099) (Part yea r, sec instructions)
54.
55.
Property Tax Cred it (See instructions page 23)
55.
56.
ew Jersey Estimated Tax Payments/Credit from 2020 tax retu rn
56.
57.
cw Jersey Earned Income Tax Credit (Sec instructions)
57.
2183
6322
Fi ll in if you had the IRS ca lculate your federal earned income credit
Fill in if you are a CU couple claimi ng the NJ Earned Income Tax Cred it
58.
Excess
ew Jersey UI/\VF/S\VF Wi thhe ld (Enclose Fonn
59.
Excess
ew Jersey Disability Insurance Witl1held (E nc lose Form NJ-2450) (See instruc tions)
J-2450) (Sec instructions)
58.
60.
Excess
ew Jersey Fam ily Leave Insura nce Wi th he ld (Enclose Fonn
6 1.
Wounded Warrior Caregivers Credit (See instructions)
n
I
il
59.
J-2450) (See instruct ions)
60.
6 1.
62.
Pass-Tiuough Bus iness Alterna tive Income Tax Credit (See instruct ions)
63.
Child and Dependent Care Credit (See instructions)
a
M
t
Fill in if you arc a CU couple claim ing the C hil d and Dependent Care Credi t
64.
Total Withholdings,
65 .
If Iine 64 is less than li ne 54, yo u have tax due. S ubtract line 64 fro m li ne 54 and enter the amou nt you owe
red its, and Payme nts (Add lines 54 tluough 63)
If you owe tax, you can still make a donation on li nes 68 through 75.
62.
63.
64.
o
N
65.
66.
If the total on line 64 is more than li ne 54, yo u have an overpayment. Subtract li ne 54 from line 64 and enter the overpaymen t
66.
67.
Amoun t from line 66 you want to credit to you r 2022 tax
67.
68.
Contribut ion to
.J . Endangered Wildlife Fund
$ 10
$20
68.
Contribution to
.J. C hil dren' s Trust Fund to Prevent hild Abuse
$10
$20
Other
69.
70.
ontribu tion to
.J . Vietnam Veteran ' Memoria l Fund
$ 10
$20
Other
70.
7 1.
Contribution to
$ 10
$20
Other
7 1.
72.
Contri but ion to U. .S. New Jer ey Educational Museum Fund
o
D
Other
69.
I0
$20
Other
72.
73 .
Other Des ignated Contri but ion (Sec instruc tions)
$ 10
20
Other
Ente r Code
73.
74.
Other Des ignated Contri but ion (See instruc tions)
$ I0
$20
Othe r
Ente r Code
74.
75.
Other Designated Contribution (See instruction )
$ 10
$20
Other
Enter Code
75.
76.
Total Adjustments to Tax Due/Overpayment amo un t (Add lines 67 through 75)
76.
77.
Balance due ( If li ne 65 is more than zero, add li ne 65 and line 76)
77.
78.
Refund amount ( If line 66 is mo re than zero, subtract li ne 76 from line 66)
78.
y
.J . Breast Cancer Researc h Fund
op
C
r
e
l
i
F
6322
4139
0
4139
T:u Dut Address
Under pena lties of perj ury, I declare that I have exami ned th is Income Tax retu rn, includ ing accompa nying sched ules and statcmcms, and to
Enc lose payment along with 1hc NJ- 1040-V payment
u,e best of my knowledge and beli e f, it is true, correct, and complete. If pre pared by a pe rson otl1er than u,e taxpaye r, thi s declaration is
,•oucher
and
tax re1urn. Use 1he labels pro,•idcd wi th the
based on a ll infonnation of whi ch the pre pare r has any know ledge.
envelope and mnil 10:
DENARA V STINGLEY
Your Signalurc
12/10/2022
Dale
Spousc·s1cu Panncr"s Signa1ure (required iffilingjoin1ly)
Date
State of New Jersey
Di\lision of Taxation
Revenue Processing Center - Payment
POBox ll l
Trenton. J 08645-0 \ 11
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -.. Include Social ccuri1y number and make check or
money order payable to:
State of New Jcrsey - TGI
You can also make a poymcnl on our wcbsi1c:
nj.gov/1axa1 ion
Refund or No Tax Due Address
•F•;,•111•,,•N
•••11•,c- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -F•i,•m•·s• •r-e•d•c,•,•1•1:.r•11•pl•o•ye•,•1•de•n•,;•r.•ca•,i•o•n-N,u•m•be•, - t usc the labels provided with the envelope and nmil to:
New Jersey Division ofTaxntion
Paid Prcparer1s Signature
LESLIE MONROE
Federal lden1 ification Number
571039776
Revenue Processing Center - Refunds
JACKSON HEWITT TAX SERVICE
•
571039776
PO Box 555
Trenton. J 0864 7-0555
6 _ _ _ _ __
•
REQUIRED
must
STINGLEY DENARA V
554318851
Schedule NJ-HCC
2021
Part I
X
Part II
C
Feb
Sep
Nov
Feb
Sep
Nov
Feb
Sep
Nov
Feb
Sep
Nov
Feb
Sep
Nov
:
:
:
:
:
Keep a copy of this schedule for your records
22222
a Employee’s social security number
554318851
OMB No. 1545-0008
b Employer identification number (EIN)
1 Wages, tips, other compensation
362407381
67,509
c Employer’s name, address, and ZIP code
2 Federal income tax withheld
12,654
3 Social security wages
UNITED PARCEL SERVICE INC, 55 GLENLAKE PARKWAY
NE, ATLANTA GA 30328
4 Social security tax withheld
5,107
67,509
5 Medicare wages and tips
6 Medicare tax withheld
2,209
67,509
7 Social security tips
d Control number
8 Allocated tips
9
e Employee’s first name and initial
Last name
Suff.
10 Dependent care benefits
11 Nonqualified plans
12a
C
o
d
e
Denara V Stingley
13
Statutory
employee
Retirement
plan
X
14 Other
336 PAVONIA AVE APT 1, NEW JERSEY CITY NJ
07302
Third-party
sick pay
12b
C
o
d
e
12c
C
o
d
e
12d
C
o
d
e
f Employee’s address and ZIP code
15 State
Employer’s state ID number
16 State wages, tips, etc. 17 State income tax
NJ
590324412
67,509
Form
W-2
Wage and Tax Statement
Copy 1—For State, City, or Local Tax Department
18 Local wages, tips, etc. 19 Local income tax
20 Locality name
6,322
2021
Department of the Treasury—Internal Revenue Service