income tax

7
OMS No. 1545-0008 c Employer's name, address, and ZIP code RW.JUHAT RAIlfAY 186 865 STONE STREET RAIlfAY, NEW JERSEY 07065 UIDI 221487305000 180 22 SI UN \lID e Employee'sname, address, and Zip code LUZ NERCADO 32 WOODVIEW AVENUE FORDS, 00628 NJ 08863 d Employee social securijy number 135-84-2049 200S 15 State Employer's state 1.0. no. 315665001 ~ W2 Wage and Tax 17 Stateincometax .2 - Statement 6755 Copy 2 for EMPLOYEE'S 19 Localincometax State, City, or Local Income Tax Return Third-party siCk pay 131811.67 18 local wages, tips, etc. 20 Locality name Department of the Treasu~nternal Revenue Service OMS No. 1545-0008 a Control number 11 Wages, tips, other compensation 12 Federal income tax withheld 645613 3 Social security wages 90000.00 5 Medicare wages and tips 130141.17 5579.36 6 Medicare tax withheld 1887.05 c Employer'sname, address, and ZIPcode RW.JUH AT RAIlfAY 186 865 STONE STREET RAIlfAY, NEW JERSEY 07065 UIDI 221487305000 180 SI UN \lID e Employee'sname, address, and Zip code LUZ NERCADO 32 NOODVIEW AVENUE FORDS, NJ 08863 00628 Third-party siCk pay 17 State income tax 6755.68 19 Local income tax 16 State wages, tips, etc. 131811.67 18 Local wages, tips, etc. 20 Locality name OMS No. 1545-0008 a Control number 11 Wages, tips, other compensation 12 Federal income tax withheld l' 5613 I 120227 3 Social security wages 90000.0 5 Medicare wages and tips 130 1887.05 26492.36 4 Social security tax wijhheld 5579.36 6 Medicare tax withheld , c Employer'sname, address, and ZIPcode RWJUH AT RAHNAY 186 i 865 STONE STREET IRAIlfAY, NEW JERSEY 07065 ! UIDI 221487305000 e Employee'sname, address, and Zip code LUZ NERCADO I 32 IfOODVIEW AVENUE FORDS, NJ 08863 d Employee social securijy number 18 Local wages. tips, etc. 20 Locality name Department of the Treasury-Internal Revenue Service OMS No. 1545.0008 a Control number 11 Wages, tips, other compensation 12 Federal income tax withheld 2 645613 I 120227.39 3 Social security wages 90000.00 5 Medicare wages and tips 130141.17 I 26492.36 4 Social security tax withheld 5579.36 6 Medicaretax withheld 1887.05 c Employer's name, address, and ZIP code RWJUH AT RAIlfAY R86 865 STONE STREET RAIlfAY,NEWJERSEY 07065 UIDI 221487305000 /' I e Employee's name, address, and Zip code LUZ NERCADO 32 IfOODVIEW AVENUE FORDS, NJ 08863 d Employee social security number 135-84-2049 200S J.:: State Employer's state1.0.no. 315665001 g W2 Wage and Tax 17Stateincometax ~ - Statement 6755.68 Copy C For 19Locatincometax EMPLOYEE'S RECORDS 18 Local wages, lips, etc. 20 Locality name II DepartmentoftheTreasury-lnlernal RevenueService DepartmenloftheTreasury-lntemal Revenue' . This information is being furnished to the Internal Revenue Service. If you are 1 This information is being furnished to the Internal Revenue Service I required to file a tax return, a negligence penalty or other sanction may be imposed (See Notice to onyouifthisincomeis taxable andyoufail to report it. onback ofC r -- a Control number 1 Wages, tips, other compensation 2 Federal income tax withheld 645613 120227 39 26492.36 3 Social securitywages 4 Social securitytax withheld . 90000.00 5579.36 5 Medicarewages and tips 6 Medicaretax withheld 130141 17 1887 05 ] 7 Social security tips 8 Allocated tips 9 Advance EIC payment 10 Dependent care benefits 11 Nonqualified plans 12a c I 44 16 b. Employeridentificationnumber 12b c I -1487305 lE 9913 78 --'Other 12c c I [ 124.50 3 EM 99.61 12d c I PF 6.23 3 7 Social security tips 8 Allocated tips 9 Advance EIC payment 10 Dependent care benefits 11 Nonqualified plans 12a See instructions for box 12 rc I 44.16 b.Employeridentificationnumber 12b -1487305 I 9913.78 14Other 12c I 124 .50 I EN 99.61 12d PF 6.23 I 7 Social securitytips" 8 Allocatedtips 9 Advance EICpayment 10 Dependent care benefits 11 Nonqualifiedplans 12a c I 3C 44 16 b. Employer identification number 12b c I 22-1487305 3E 9913 78 14Other 12c c I SDI 124.50 3 UNEN '99.61 12d c I \llDPF 6.23 s 7 Social security tips 8 Allocated tips 9 Advance EIC payment 10 Dependent care benefits 11 Nonqualified plans 12a See instructions for box 12 C I 44.16 b. Employeridentificationnumber 12b 22-1487305 E I 9913.78 14Other 12c SDI 124 .50 I UNEN 99.61 12d \llDPF 6.23 I .

Transcript of income tax

OMS No. 1545-0008

OMS

No.

1545-0008

a Control number

1 Wages, tips, other compensation

2 Federal income tax withheld

a Control number

11 Wages, tips, other compensationI

12 Federal income tax withheld

645613

120227 393 Social securitywages 90000.00 5 Medicarewages and tips 130141 17

26492.364 Social securitytax withheld 5579.36 6 Medicaretax withheld

5613

1202273 Social security wages

26492.364 Social security tax wijhheld 5579.36 6 Medicare tax withheld

.

90000.05 Medicare wages and tips

1887 05 180

l' ]

130, c Employer'sname, address, and ZIPcode RWJUH AT RAHNAY 186i

1887.05

c Employer's name, address, and ZIP code

RW.JUHAT RAIlfAY 186 865 STONE STREET RAIlfAY, NEW JERSEY 07065 UIDI 2214873050007 Social security tips 10 Dependent care benefits 8 Allocated tips 11 Nonqualified plans

865 STONE STREETJERSEY

IRAIlfAY, NEW! 9 Advance EIC payment 12a c

UIDI7 Social securitytips" 10 Dependent care benefits

07065 221487305000 9 Advance EICpayment 12a c 3C 12b c

8 Allocatedtips 11 Nonqualifiedplans

I I

44

16b. Employer identification number

II

44

16

b. Employeridentificationnumber

12b clE

22 -1487305 --'Other SI [ 124.50 UNEM 99.61 PF \lID 6.23e Employee'sname, address, and Zip code LUZ NERCADO 32 WOODVIEW AVENUE NJ FORDS,

12c c

9913

78

3 12d c 3

I I

22-1487305 14Other SDI 124.50UNEN '99.61

3E 12c c

9913 78

\llDPF 6.23e Employee'sname, address, and Zip code LUZ NERCADOI

s

3 12d c

I I

00628 08863

32

IfOODVIEW

AVENUE

FORDS,Third-party siCk pay

NJ

08863

d Employee social securijy number

d Employee social securijy number

135-84-2049

200S 15 State Employer's state 1.0. no. 315665001 tax ~ W - 2 Wage and Tax 17 Stateincome6755 .2 StatementCopy 2 for EMPLOYEE'S State, City, or Local Income Tax Return19 Localincometax

131811.6718 local wages, tips, etc. 18 Local wages. tips,etc.

20 Locality name

20

Locality

name

Department of the Treasu~nternalOMS No. 1545-0008

Revenue ServiceOMS No. 1545.0008

Department

of the

Treasury-Internal

Revenue

Service

a Control number

11 Wages, tips, other compensation 3 Social security wages

12 Federal income tax withheld

a Control number

11 Wages, tips, other compensation

12 Federal income tax withheld

645613 90000.005 Medicare wages and tips

645613

I

120227.39 90000.00

26492.364 Social security tax withheld 5579.36 6 Medicaretax withheld 1887.05

3 Social security wages

5579.366 Medicare tax withheld

5 Medicare wages and tips

130141.17c Employer'sname, address, and ZIPcode 186 RW.JUH AT RAIlfAY 865 STONE STREET 07065 RAIlfAY, NEW JERSEY UIDI 2214873050007 Social security tips 10 Dependent care benefits 8 Allocated tips 11 Nonqualified plans

1887.05 180

2RWJUH AT RAIlfAY R86 865 STONE STREET

130141.17c Employer's name, address, and ZIP code

I

RAIlfAY, EW JERSEY N9 Advance EIC payment 12a See instructions for box 12 7 Social security tips 10 Dependent care benefits

07065

UIDI 2214873050008 Allocated tips 11 Nonqualified plans 9 Advance EIC payment

/'I12a See instructions for box 12

rc b. Employeridentification number -1487305

I

44.16 9913.78b. Employeridentificationnumber 22-1487305

C I12b

44.16 9913.78

12b 12c

II

E12c12d

I

14Other SI I 124 .50 UN EN 99.61 PF \lID 6.23e Employee'sname, address, and Zip code LUZ NERCADO 32 NOODVIEW AVENUE

12d

I00628 08863Third-party siCk pay

14Other SDI 124 .50 UNEN 99.61 \llDPF 6.23e Employee's name, address, and Zip code

I

IAVENUE

.

LUZ NERCADO32 IfOODVIEW

FORDS,

NJ

FORDS,d Employee social security number

NJ

08863

135-84-204916 State wages,tips,etc.

131811.6717State income tax

200S J.:: State Employer's state1.0.no. 315665001g ~ W -2 StatementWage and Tax 17 Stateincome tax 18 Local20wages, lips, etc.

18

Local

wages,

tips,

etc.

6755.6819 Local income tax

6755.6819 Locatncometax iLocality name

20 Locality name

Copy C For EMPLOYEE'S RECORDS. This information to is being furnished

Department oftheTreasury-lnlernal RevenueServiceto the Internal Revenue or other This information is

Departmenl oftheTreasury-lntemal Revenue'Service. sanction If you are imposed (See Notice required file a tax return,

being

furnished

to the Internal Revenue

Service

III

a negligence

penalty

may

be

to

on you if this income istaxable

andyoufail toreport it.

onback of C 1

--

r

Form

1040X-------. . ___ ___n - --Your first name

Department of the Treasury ~ Internal Revenue Service

(Rev November 2005) ----

Amended U.S. Individual Income Tax Return~

OMS No. 1545-0074

See separate instructions. ended dedMI MI last name last name

2005 - - - -

1

-. -- - -

_ __

,Your social security number

LUZ R. MERCADO Please If a joint return, spouse's first name print or Homeaddress(no.and street)or P.O. box if mail is not deliveredto your home type 32 WOODVIEW AVENUECity, townor postoffice.If you havea foreignaddress,see instructions.

135-84-2049Spouse's social security number Apt no. State ZIP code Phonenumber

732-499-6117

For PaperworkReductionAct Notice, see instructions.

FORDS, NJ 08863A Bcheck here.

If the address shown above is different from that shown on your last return filed with the IRS and you would like us to change it,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _. . . . . . . . .

Filing status. Be sure to complete this line. Note. You cannot change from joint to separate returns after the due date.On originalreturn ~

On this return ~ Single Married filing jointly . If the qualifyingpersonis a child but notyour dependent, ee instructions. s

D D

Single

D D

Married filing jointly

D D

Married filing separately Married filing separately

~ ~

Head of household Head of household.

D D

Qualifying widow(er) Qualifying widow(er)

Use Part II on page 2 to explain any changes

amount or aspreviously adjusted (see instructions) 1 105,367.

A Original

B Net change amount of increaseor (decrease) explain in Part II

C Correct amount105,367.

Income and Deductions1 2Adjusted gross income (see

(see instructions) instructions) ... .. .. ...... . ... .

Itemizeddeductionsor standarddeduction(see instructions). . . . . . . . . . . .

3 4 5 6Tax Lia. 7 8

Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Exemptions.If changing,fill in Parts I and II on page2. . . . . Taxableincome.Subtract line 4 from line 3. .. .. ...... . . ...

2 3 4 5

32,432. 72,935. 19,200. 53,735.

-3,200. 3,200.

32,432. 72,935. 16,000. 56,935.

Tables Tax(see instructions). Methodusedin columnC. --------Credits (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

67

12,298.

12,298.12,298. 12,298. 26,492.

Subtract line 7 from line 6. Enterthe result but not lessthan zera . . . . . . . . 8 12,298. 9 Other taxes (see instructions).. .. . . . . . . . . . . . . . . . . . . . . . . . . . 9 10 Total tax. Add lines 8 and 9. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 12,298. 11 Federalincometax withheldand excesssocial securityand tier 1 RRTAtax withheld. If changing,see instructions.. . .. . 11 26,492. 12 Estimatedtax payments,including amount applied from prior year's return. . . . . . . . . . . . . . . . . . . . 12 Payments 13 Earned income credit (EIC). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 14 Additionalchild tax credit from Form 8812.. .. . . .... . . . . .. . 14 15 Creditsfrom Form2439, Form4136, or Form 8885......... 15 16 Amount paid with request for extension of time to file (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Amount of tax paid with original return plus additionaltax paid after it was filed. . . . . . . .. .. . . . . . . . . . . . 18 Total payments. Add lines 11 through 17 in column C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Refund or Amount You Owe 19 Overpayment,if any, as shownon original return or as previouslyadjusted by the IRS.. . . . . . . . . . . . . . . 20 Subtract line 19from line 18 (see instructions)..................................................... 21 Amountyou owe. If line 10, columnC, is more than line 20, enter the differenceand see instructions. 22 If line 10, column C, is less than line 20, enter the difference.. .. .. . . . . . . . . . . .. .. . . . . . . .. . . . . . . . . . . . 23 Amount of line 22 you want refunded to you.. ........ . ......... .... ..... ... .... .. ...... .. . . .. ..... 24 Amount of line 22 you wantapplied to your estimated tax. . . .. 24

bility

16 17 18 19 20 21 22 231

26,492 14,194. 12,298.

.

I I

'I

N

I

Sign HereJoint retum? See instrs. rceep a copy or your records.

Under penalties of perjury, I declare that I have filed an ori\linal return and that I have examined this amended return, includingaccomanying schedules and statements,and tothe bestofmyknowledgend belief,thISamendedreturn true,correct,and complete. eclaration f preparer(0 er thantaxpayer)is a is D o based on all informationof whichthe preparer has any knowledge.

IYoursignature Preparer's Date Date Spouse's signature. If a joint return, both must sign

II :

Date

Use OnlyBAA

Paid Preparer's

signatureFirm's name

JACK KAPLAN,

EA

;1yJe.lf:

IX]

I

(0lt.0ursif se -employed), address,and ZIPcode

21E_n________________________ 9grgy____________________Avenel, NJ 07001FDIA1812l 12/02/05

EIN

Preparer'sSSNor PTIN PO 0 0 2 2 4 3 7 22-3761453

Phoneno.

(732)

602-9010

Form 1040X (Rev 11-2005)

I

!':orm 1040X (Rev 11-2005)

LUZ R. MERCADO Parl1U:1j Exemptions. See Form 1040 or 1040A instructions.Complete this part only if you are: Increasing or decreasing the number of exemptions claimed on line 6d of the return you are amending, or Increasing or decreasing the excemption amount for housing

135-84-2049 A Original number of exemptions reported or as previously adjusted

Page 2 C Correct number of exemptions

individuals displacedby HurricaneKatrina.

B Net change

25 Yourselfand spouse

.. . ... .. .. .. ..

.. ... ....

1

1

Caution. If someone can claim you as a dependent, you cannot claim an exemption for yourself. 26 Your dependent children who lived with you ... . .. .27 Your dependent children who did not live with you due to divorce or separation. . . . . .

4

-1

3 1 5

28 Other dependents . . .. .. . . . . .. . . . . . . .. . . . . . . . . . . . . . . .. .. . . . . . . . . . 29 Total number of exemptions. Add lines 25 through 28. . . . . . . . . . . . . . 30 Multiplythe number of exemptions claimed on line 29 by the amount listed below for the tax year you are amending. Enter the result here and on line 4. Tax Exemption But see the instructions for line 4 if ~ amount the amount on line 1 is over: 2005 $3,200 $109,475 2004 3,100 107,025 2003 3,050 104,625

1 6

-1

.

2002 3,000 103,000 31 If you are claiming an exemption amount for housing individuals displaced by Hurricane Katrina, enter the amount from Form 8914, line 2 (see Instructions for line 4) 32 Add lines 30 and 31. Enter the result here and on line 4 . . . . . . . . . ..

~~I32

19,200.

-3,200.

16,000.

19,200.

-3,200.

16,000.

33 Dependents (children and other) not claimed on original (or adjusted) return: (a) First name Last name -I (b) Der endent's socia secunty number

(c) Dependent's relationship to you

(d)v' if qualifying child for child tax credit

Number of children on 33 who: lived with you ~ . did not live with you due to divorce or separation (seeinstructions)..

D D

~

Dependents on 33 not entered above ~

Explanation of ChangesEnter the line number from page 1 of the form for each item you are changing and give the reason for each change. Attach only the supporting forms and schedules for the items changed. Ifyou do not attach the required information, your Form 1040X may be returned. Be sure to include your name and social security number on any attachments.If the change relates to a net operating loss carryback or a general business credit carryback, attach the schedule or form thatshows the year in which the loss or credit occurred. See the instructions. Also, check here. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..~

DEPENDENT ANNALIZA

MERCADO WAS DELETED FROM ORIGINAL

RETURN

PartIIIIf you did not

Presidential Election Cam ai n Fund. Checkinpreviously want $3 to go to the fund but now want

If a joint return and your spouse did not previously

below will not increase your tax or reduce your refund. here. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. want $3 to go to the fund but now wants to, check here. . . . . . . . . . . . . . . . . . . . . . . . .. .to, check

~

~

Form

1040X (Rev 11-2005)

FDIA1812L

12102105

I

SCHEDULE A(Form 1040)Department of the Treasury Internal Revenue Service Name(s) shown on Form 1040

Itemized Deductions~

OMS No. 1545-0074

Attach to Form 1040.for Schedule A (Form

(99)

~

See Instructions

1040).

Attachme, " Sequence-,No. Your social security number

200507

LUZ R. MERCADOMedical and Dental ExpensesCaution. Do not include expenses reimbursed or paid by others.1 Medical

and dental expenses (see instructions).

2

Enteramount fromForm1040,ine3& . . . .. l

~

.. ..... .. .. .... .... .. ....

3 4

Multiply line 2 by 7.5% (.D75) Subtract line 3 from line 1. If line 3 is more than line 1, enter -D-.. . . . . . . . . . . . . . . . . . . . . . . . . . . 5 State and local (check only one box):

U

4

o.

Taxes You Paid (Seeinstructions.)

a b6 78

~ Incometaxes, orDtaxes. List type

1-. .............

51

6,986.

General sales taxes (see instructions) Real estate taxes (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . .. 6 Personal property taxes. . . . .. .. . . .. .. . . .. .. .. . . . . . . .. . . . . . . .. 17and amount~

J

5,987..1 915,437. 12,973.

Other

_ __ _ _ _ _ __ _ _ _

Interest You Paid

8 ~ ,9 Addlhles5through-8~ ~ ~ ~ ~.~~ .~.-:.-:.-:.-:.-:.-:.-:.-:.-:.-:.-:.~ 10 Home tginterest pointseported onForm m and r toyou 1098 Se.e.St.1 10 11 Home mortgage interest otreported youonForm1098. If paidto theperson n tofrom whom you boughtthe home, see instructions and showthat person'sname, identifying number, and address ~

(Seeinstructions.)

---------------------------------------------------------------------------------------12 POlntSn-;;-t re~rt~toyo~ ~ Fo~ 1098:S; ;nstrsfo~spcl~u~s-:-.-:Stult. _:_21 I 12 13 Investmentinterest. Attach Form 4952 if required.(See

Note. Personal interestis not deductible.Gifts to Charity If you made a gift and got a benefit for it, see instructions.

180.

instrs.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..

14 Add lines 10 through 13.. .. .. .. .. .. .. .. .. .. .. . .. .. .. .. . .. .. . . .. . . .. .. .. .. . .. .. . .. .. .. .. .. I 1415a Total gifts by cash or check. If you made any gift of $25D or more, see instrs .. . .See..Statement.b Gifts by cash or check after August 27, 2005, that you elect to treat as qualified contributions(see instructions).. .. .. .. ...

W

15,617.

31 15al

2,200.

~ .. ... .. .. .. I 16 m0i181

16

Other than by cash or check. If any gift of $25D or more, see instructions. You must attach Form 8283 if

over$50D. .. ... ... ..17 Carryover

..

from prior year. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..

18 Addlines15a,16,& 17...................................................................Casualty and Theft Losses Job Expenses and Certain Miscellaneous Deductions 19 Casualty or theft loss(es). Attach Form 4684. (See instructions.). . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Unreimbursed employee expenses - job travel, union dues, job education, etc. Attach Form 21D6 or 2106-EZ if required. (See instructions.) ~ --------------

2,200.

19 I

o.

----------------------------------------------------------21 22Tax preparation fees. . . . . .. .. . . . . .. .. .. .. . . . . . . . . . . . . . . . . . . . .

210. 3,539.

(See instructions.)

Other expenses - investment, safe deposit box, etc. Listtype and amount~

_ __ _ _ __ _ _ __ _ _ _ _ __ _ _ _

Other Miscellaneous Deductions Total Itemized Deductions

23 Add lines 20 through 22. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,749. 24 Enter amountromForm1040,ine38. . . .. 24 f l 105, 367 25 Multiply line24by2%(.02). . .. .. .. .. .. .. .. .. . .. .. . .. .. .. .. . . 25 . 2 107 26 Subtract line 25 from line 23. If line 25 is more than line 23, enter -D-. . . . . . . . . . . . . . . . . . . . . . . 27 Other - from list in the instructions. List type and amount ~ _ _ _ _ __ _ _ _ _ __ __ _

~~~~ka~~~e~t_~__________________

.

,

.27

1,642.

-------------------------------------------28 Is Form 1040, line 38, over $145,950 (over $72,975 if MFS)?[!] No. DYes.29

o.

Your deduction is not limited. Add the amounts in the far right column for lines 4 through 27. Also, enter this amount on Form 1040, line 40. Your deduction may be limited. See instructions for the amount to enter.

}

~I 28

If YOU elect to itemize deductionseyenthouahthey are less than your standarddeduction.check here ~

BAA

For Paperwork

Reduction Act Notice, see Form 1040 instructions.

FDIA0301L

11/18/05

Schedule A (Form 1040) 20D5

I

Form

6251(99)

(Rev January 2006) Department of the Treasury Internal Revenue Service Name(s) shown on Form 1040

Alternative MinimumTax - Individuals~ ~ See separate instructions. Attach to Fonn 1040 or Form 1040NR.

OMS No. 1545-0074

Attachment Sequence No.

200532

Yoursocial

security number

See instructions for how to comIf filing Schedule A (Form 1040), enter the amount from Form 1040, line 41 (minus any amount on Form' 8914, line 2), and go to line 2. Otherwise, enter the amount from Form 1040, line 38 (minus any amount on Form 8914, line 2), and go to line 7. (If less than zero, enter as a negative amount.). . .. .. . . . . . . . . . . . . . . . . . . Medical and dental. Enter the smaller of Schedule A (Form 1040), line 4 or 2- 1/2% of Form 1040, line38.. . .Taxes from Schedule A (Form 1040),

23

line 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4 5 6 7 89

Enter the home mortgage interest adjustment, if any, from line 6 of the worksheet in the instructions. . .. .. . . Miscellaneous deductions from Schedule A (Form 1040), line 26. .. .. .. . . .. . . . . .. . . . . . . . . . . . . . . .. . . . . .. .. . . If Form 1040, line 38, is over $145,950 (over $72,975 if married filing separately), enter the amount from line 9 of the Itemized Deductions Worksheet in the Instructions for Schedules A and 8 (Form 1040). .. Tax refund from Form 1040, line 10 or line 21 . . .. . . .. .. . . . . . . . . .. .. . . . . .. . . . . .. . . . . . . . . . . . . . . .. .. . . .. . . .. Investment interest expense (difference between regular tax and AMT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Depletion (difference between regular tax and AMT)

1 2 3 4 56 7 8

72,935. 12,973. 1,642.

. . . . . . . . . . . . .. . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . 9 10 Net operating loss deduction from Form 1040, line 21. Enter as a positive amount.. 1011 12 13 14 1516

Interest from specified private activity bonds exempt from the regular tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Qualified small business stock (7% of gain excluded under section 1202). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Exercise of incentive stock options (excess of AMT income over regular tax income). . . . . . . . . . . . .. .. .. .. . . .. Estates and trusts (amount from Schedule K-1 (Form 1041), box 12, Code A) ... ,... .. .. Electing large partnerships (amount from Schedule K-1 (Form 1065-8), box 6) . .. . . . . . . . . . . . . . . .. . . . . .. . . ..Disposition of property (difference between AMT and regular tax gain or loss)

11 12 13 14 15 1718 19 20 2122

. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 16

1718 19 20 2122

Depreciation on assets placed in service after 1986 (difference between regular tax and AMT). .. .. ..Passive activities (difference (difference between between between AMT and regular tax income or loss) . . . . . . . . . . . . . . . _. . . . . . . . . . . . . . .. or loss).. . . .. . . . . . . .. . . . . , . . . . . . . . . .. .. .. Loss limitations Circulation Long-termMining costs

AMT and regular tax income

costs (difference contracts(difference

regular tax and AMT), . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. AMT and regulartax and AMT)

(differencebetween

betweenregular

tax income).

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..regular tax and AMT). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1, 1987. . . .. . . . . . . .. . . .. . . . . . . . . . . . . . . . . . . . . . . .. . . ..

23 24 25 26 27

Research

and experimental

costs (difference

between

23 24 25 26 27

Income from certain Intangible drilling

installment

sales before January

costs preference. including

. . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. related adjustments. . . .. . . . . .. . . . . . . . . . . . . . . . . .. . . .. . . . . .. . . ..

Other adjustments, Alternative

income-based loss deduction.

tax net operating

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..

28 Alternative minimum taxable income. Combine lines 1 through 27. (If married filing separately and line 28is more than $191,000, see instructions.),

~artU29

I Alternative

1 28

87,550.

Minimum Tax

Exemption. (If this form is for a child under age 14, see instructions.)

IF your filing status is

...

AND line 28 is

not over.

..

THEN enter on

line 2958,000 29,000

...

Single or head of household $112,500.............. Married filing jointly or qualifying widow(er). . . . . . . . . . . . . . 150,000. . . . . . . . . . . . . . Married filing separately. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75,000. . . . . . . . . . . . . . If line 28 is over the amount shown above for your filing status, see instructions.30Subtract

$40,250

}

.... ...

40,250. 47,300.

line 29 from line 28. If zero or less, enter -0- here amI on lines 33 and 35 and stop here.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

31

-If you reported capital gain distributions directly on Form 1040, line 13; you reported

32 33

2 and enter the amount from line 55 here. ..... .. All others: If line 30 is $175,000 or less ($87,500 or less if married filing separately), multiply line 30 by 26% (.26). Otherwise, multiply line 30 by 28% (.28) and subtract $3,500 ($1,750 if married filing separately) from the result. Alternative minimum tax foreign tax credit (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

qualified dividendson Form 1040,line 9b; or you had a gain on both lines 15 and 16 of ScheduleD (Form 1040) (as refiguredfor the AMT, if necessary),complete Part III on page

-

}

12,298.

J33I

Tentative

minimum

tax.

Subtract

line

32 from

line

31. . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12,298.

34

Tax from Form 1040, line 44 (minus any tax from Form 4972 and any foreign tax credit from Form 1040, line 47). If you used Schedule J to figure your tax, the amount for line 44 of Form 1040 must be refiguredwithout using Schedule J (see instructions).

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341 35

9,729.2,569.

35 Alternative minimum tax. Subtract line 34 from line 33. If zero or less, enter -0-. Enter here and on Form 1040,line 45. .. .. .. .. .. . .. .. .. ... . . . .. BAA For Paperwork Reduction Act Notice, see separate instructions. FDIA5312L 1113/06 0

Form 6251 (2005) (Rev 1-2006)

I

NJ-'040X 2005

STATE OF NEW JERSEY AMENDED INCOME TAX RESIDENT RETURN, 2005, Ending

For Tax Year Jan. Dec 31,2005, Or Other Tax Year BeginningYou must enter your social security number below YourSocialSecurityNumber

,

,LastName,First Nameand Initial (Jointfilers enterfirst nameand initial of each

T A p A Y E R

- Enterspouselast nameONLYifdifferent)

x

135-84-2049Spouse'sSocialSecurityNumber

MERCADO 32

LUZ R.AVENUEState ZIP Code

Homeaddress(Numberand Street,includingapartmentnumberor rural route)

WOODVIEW

County/Municipality Code

City,Town,Post Office

D E N T I F I c A T I N A N0

I

FORDS,

NJ 08863FromMONTH DAY YEAR

NJ RESIDENCY If you were a New Jersey resident for ONLY part of the STATUS taxable year, give the period of New Jersey residency: FILING STATUS ON ON 6 Regular

toMONTH DAY YEAR

EXEMPTIONS X Yourself - Spouse Domestic "'"" Partner Yourself - Spouse. . . . . . . . . . . . . -8 Blindor Disabled L- Yourself - Spouse. . . . . . . . . . . . .

As Originally Reported

Amended

U

6 7 8

1

1

ORIGINALAMENDED RETURN RETURN 1

7 Age 65 or Over

10 3 11 Dependents attending colleges. . . . . . .. .. . . . . .. . 11 _ Married,iling separateeturn f r 4 X X Headfhousehold o 12Totals (ForLine12a- Add Lines ,7,8,and11).. ... .. 12a 6 s 5 Qualifying idow( w er) (For Line 12b - Add Line 9 and Line 10)... . . . .. . 12b 13 GUBERNATORIAL ELECTIONS FUND Checkingbelow will not increaseyour tax or reduceyour refund.10Number of other dependents. . . . . . . . .. .. . . . . .. .

D s T A T u

2 -

-

_

Single Married,ilingjointreturn f

9 Numberof your qualified dependent children. . . . . . . . . . . . ..

9

41 1 5

31 1 4

-

-

Checkhere--Checkhere---

R If you did not and if spousedid not previouslywantfund but $1 towant itthedo so.but now wants it to do so. joint return previouslywant to have $1 go to the to have now go to to fundAs Originally Reported

14 Wages,salaries,tips, and otheremployee compensation. 15a Taxable Interest Income.. 15 b xLr:T .i

. . . . . . . . . . . . . . . . . . . . . . . . 14 .. ...... . . .. ...... .... . 15a: .? .:. i.I. ..... 15b

131,81218

".Ii!

Amended (See Instructions) '0'*"I' I

[

r

131,812

18

16 Dividends.. .. . . . . . . . . .. . . .. . . .. .. . . . . .. . . . . . . . . . 16 17 Net profits from business. . . . . . . . . . . . . . . . . . . . . . . . 1718 Net gains or income from dispositionof property.

!J@

I

19 Pensions,Annuitiesand IRA Withdrawals

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 a TaxableAmount Received... 19ab Less New Jersey Pension Exclusion. ..........

:

;

19b

' .1tIpc .TI,@

$I

c Subtract Line 19b fromLine 19a

. . . . . . . . . . . . . . . . . . . . 19c20 21 22 23 24

20 Distributive Share of Partnership Income. . . . . . . . . . 21 Net pro rata share of S Corporation Income. . . . . . . 22 Net gain or income from rents, royalties, patents and copyrights. . .. .. . . . . .. . . . . . . .. .. .. .. . 23 Net GamblingWinnings... .. ....... .............. 24 Alimony and separate maintenancepayments received. .............................

::

",'.

,@

TI

@

25

Other. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25if 26NJIA0412L E

..@pI1 @;11III

26 Total Income (Add Lines 14, 15a, 16, 17, 18, 19c,20, 21, 22, 23, 24, and 25)

@

.. .. . .. .. .. .. .. .. . .. .. .

131,83012129/05

,

..

4

"*

131,830

I

LUZ R. MERCADOAs Originally27 28 29 30 31 32 33 34 35 36 37 38 3940 41

-'135-84-2049 Amended830 "

Page 2 -

Total Income (From Line 26, Page 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Other Retirement Income Exclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 New Jersey Gross Income (Subtract Line 28 from Line 27).. . . . . . . . . . . . 29 Exemptions (See instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Medical Expenses (See instructions NJ-104D} . . . . . . . . . . . . . . . . . . . . . . . . . 31 Alimony and separatemaintenancepayments.... .. .. ...... ... . .. .. ... 32 Qualified Conservation Contributions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Health Enterprise Zone Deduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Total Exemptionsand Deductions(Add Lines 30, 31,32,33, and34}... 35 Taxable Income (Subtract Line35fromLine29)...... ......... . ....... 36 37 PropertyTax Deduction... ........ . ..... .... .... .... ......... . ....... NEWJERSEYTAXABLEINCOME(Subtract Line 37 from Line 36)...... 38TAX: (see instructions). . .. .. .. .. . . . . .. .. . . . . ... . . . .. .. . . .. .. . . . . . . .. . 39 Credit For Income Taxes Paid To Other Jurisdictions.. ......... . ....... 40 Balance of Tax (Subtract Line 40 from Line 39). . . . . . . . . . . . . . . . . . . . . . . . 41

Reported 131

(See Instructions) 131 830 131 830 7 000

131 830 8.500 "

8.500 123 330 5.987 117 343 3 708'.'.

7 124 5 118 3i.....

000 830 987 843 791

3 708 3 708 6.756

37913 791 6 756

42 43 44 45 46 47

UseTax Due on Out-of-StatePurchases(see instructionsNJ.l040).. . . . 42 Total Tax (Add Line 41 and Line 42). . . . . . . . . .. . . . . . . . . . . .. .. . . . . . . .. . 43 Total New Jersey Income Tax Withheld.. . . . . .. .. . . .. .. . . .. .. . . . . . . .. . 44 Property Tax Credit. . . . . .. .. . . . . . . . . . . . . . . . . .. . . . . .. . . . . .. .. . . . . . . .. . 45 NewJerseyEstimatedTax Payments/Creditfrom 2004tax return.. . . . . . 46 New Jersey Earned Income Tax Credit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

'"f

48 EXCESS New Jersey UI/HCIWD Withheld (see instructions NJ-104D). . . . 48 49 EXCESS New JerseyDisabilitYInsuranceWithheld(see instructions NJ-1040).. . . . . . . . . . . 49 50 Amount Paid with original return, assessments and/or with requestfor extension to file. .. . . .. .. . . . . .. . . . . . . . . . . .. . . . . .. . . . . . . . . . . . . .. . . . (Add Lines 44 through 50}

50 6.756 3 048 3.708 6 756 3 048 3.708 83

51 52 53 54 55 56

Total payments

Refund previously issued from Original Return. . . . . . . . . . . . . . . . . . . . . . . . . 52

.. ..... .. .. .... ..... .. ... ... 51

:1 Net Payments(SubtractLine 52 from Line 51).... .... .. .. ........ . ... . 53 O . If payments(Line 53) are LESSTHANtax (Line43) enter AMOUNT FTAXYOUOWE. . .. .... .. .. .... 54 If payments (Line 53) are MORE THAN tax (line 43) enter OVERPAYMENT. ................ ........ .... 55 Amount of Line 55 to be (A) REFUNDED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56A

(B) CREDITED to vour 2006 tax.. .. .. .. .. .. .. . .. .. .. . .. .. .. .. .. .. .. .. .. .. .. 56BEnterbelow,name,socialsecuritynumber,and addressas shownon orinal return(if sameas indicatedon page I, write'Same').If changing from separateto joint return,enter names, socialsecuritynumbers,and addresses usedon originalreturns. (Note: ou cannotchangefrom jointto separatereturnsafterthe duedate has passedunlessyou havedoneso for Federal tax purposes.)

SameYour SSN Spouse's SSNEnterlast name,first name,middleinitial, socialsecuritynumber,andbirth year of yourdependents whowerenot claimedas dependents originalreturn. on

Explanationof Changes to Income,Deductions, and Credits. Enter the linereference for whichyou are reportinga change and give the reason foreach change. See Statement 1

Ifamending Line40, completethe calculations below: (IncomefromOtherJurisdictions)(Income from New Jersev sources)

X(NewJerseyTaxline 39)

=Pay amount on line 54 in full. Write SSN(s) on check or money order and make payable to: STATEOF NEWJERSEY TGI

Under the penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knOWlede and belief, it is true, correc and complete. If prepared by a person other than taxpayer, this declaration is based on all information 0 which the preparer has any knowledge.

Yoursignature SIGN HERE PaidPreparer'sSignature

-

Date

-

-

Spouse'ssignature(If filing jointly,BOTHmustsign.) FederalEmployerIdentification Number

Mail your return to: Divisionof Taxation Revenue Processing Center POBox 111 Trenton,NJ08645-0111

JACK KAPLAN, EAFirm'sName

POO022437FederalEmployerIdentification Number

Kaplan

& Bender

1030 St. GeorgesAvenel,Division Use

Ave. 07001 3 4

22-3761453 5 6

NJ

If Refund: Divisionof Taxation Revenue Processing Center PO Box555 Trenton,NJ 08647-0555 You may also pay bye-check orcredit card. 7

1

2

NJIA0412L

12/29/05

I