2022 NJ-1040

New Jersey Resident Income Tax Return

For Privacy Act Notification, See Instructions

NJ-1040 N900
2022
Page 1

Your Social Security Number (required) Last Name, First Name, Initial (Joint Filers enter first name and middle initial of each. Enter spouse’s/CU partner’s last name ONLY if different.)

X XX XX XX XX
140402832 XX XX XX XX WILLIAM
FLEMING XX XX XX XX R
XX XX XX XX XX XX XX XX XX XX XX XX XX XX

Spouse’s/CU Partner’s SSN (if filing jointly) XX XX XX XX XX XX XX XX XX XX XX XX XX XX XX XX XX XX XX XX XX XX

X XX XX XX XX
Home Address (Number and Street, including apartment number)
County/Municipality Code (See Table page 50) XX
629XX XX
A XX XX XX XX XXRINGOES
ROSEMONT XX XX XX XXRD
XX XX XX XX XX XX XX XX XX XX
X XX X
1001
City, Town, Post Office State ZIP Code
XX XX XX XX XX XX XX XX XX XX XX XX X
SERGEANTSVILLE X
NJX X08557
XX XX XX XX X

Driver’s License Number (Voluntary) (See instructions)

XX XX XX XX XX XX XX X
F52547857911454

Federal extension filed.

The address above is a foreign address.
Your address has changed.
Death certificate is enclosed.
Do not want a paper form next year.
I authorize the Division of Taxation to discuss my return and enclosures with my preparer.
NJ-1040-O is enclosed.

Gubernatorial Elections Fund Note: This does not reduce your refund or increase your balance due.
Do you want to designate $1 to the Gubernatorial Elections Fund? You X Yes No
If joint return, does your spouse want to designate $1? Spouse/CU Partner Yes No

Direct Deposit Information

dd1. Direct deposit indicator (1 for direct deposit, 4 for no direct deposit) dd1. 1
dd2. Account type (C for checking, S for savings) dd2. C
dd3. Fill in the checkbox if the direct deposit is going to an account outside the United States dd3.
dd4. Routing number dd4. 121122676
dd5. Account number dd5. 157533273700
 Name(s) as shown on Form NJ-1040
XX XX XX XX XX
FLEMING XX XX XX XX
WILLIAM R XX XX XX XX XX XX XX XX XX XX XX

Your Social Security Number

NJ-1040 XX XX XX XX X
140402832 N900
2022
Page 2

Part-year residents, provide months/days you were a New Jersey resident during 2022: Fiscal year filers only:
From: XX XX 22 To: XX XX 22 Enter month of your year end 2022

Filing Status
Fill in only one.

1. X Single
2. Married/CU Couple, filing joint return
3. Married/CU Partner, filing separate return X XX XX XX XX
4. Head of Household Enter spouse’s/CU partner’s SSN
5. Qualifying Widow(er)/Surviving CU Partner
Indicate the year of your spouse’s/CU partner’s death: X 2020 X 2021

Exemptions
Fill in the ovals that apply. You must enter a total in the boxes to the right and complete the calculation.

6. Regular X Self Spouse/CU Partner X Domestic Partner 1 1000

x $1,000 = _________
7. Senior 65+ (Born in 1957 or earlier) Self Spouse/CU Partner 0 x $1,000 = 0
_________
8. Blind/Disabled Self Spouse/CU Partner 0 x $1,000 = 0
_________
9. Veteran Self Spouse/CU Partner 0 x $6,000 = 0
_________
10. Qualified Dependent Children =
x $1,500 0
_________
11. Other Dependents =
x $1,500 0
_________
12. Dependents Attending Colleges (See instructions) =
x $1,000 0
_________
13. Total Exemption Amount (Add totals from the lines at 6 through 12) 13. 1000 .

14. Dependent Information. Provide the following information for each dependent.
Last Name, First Name, Middle Initial Social Security Number Birth Year No Health Insurance
a. _________________________________________________________________
b. _________________________________
________________________________
c. _________________________________________________________________
d. _________________________________________________________________
 Name(s) as shown on Form NJ-1040
XX XX XX XX WILLIAM
FLEMING XX XX XX XX XX XX XX XX XX XX XX XX
XX XX XX XX R

Your Social Security Number

NJ-1040 XX XX XX XX X
140402832 N900
2022
Page 3

15. Wages, salaries, tips, and other employee compensation (State wages from Box 16 of enclosed W-2(s)) (See instructions) 15. X XX XX XX XX .
65000
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 profits 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. Taxable pensions, annuities, and IRA distributions/withdrawals (See instructions) 20a. .
20b. Excludable pension, annuity, and IRA distributions/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. 65000 .
28a. Pension/Retirement 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. 0 .
29. New Jersey Gross Income (Subtract line 28c from line 27) (See instructions) 29. 65000 .
30. Exemption Amount (Enter amount from line 13. Part-year residents see instr.) 30. 1000 .
31. Medical Expenses (See Worksheet F and instructions) 31. .
32. Alimony and separate maintenance payments (See instructions) 32. .
33. Qualified 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. .
37a. NJBEST Deduction 37a. .
37b. NJCLASS Deduction 37b. .
37c. NJ Higher Ed. Tuition Deduction 37c. .
38. Total Exemptions and Deductions (Add lines 30 through 37c) 38. 1000 .
39. Taxable Income (Subtract line 38 from line 29) 39. 64000 .
40a. Total Property Taxes (18% of Rent) Paid (See instructions page 25) 40a. .
40b. Indicate your residency status during 2022 (fill in only one) Homeowner Tenant Both
41. Property Tax Deduction (From Worksheet H) (See instructions) 41. .
42. New Jersey Taxable Income (Subtract line 41 from line 39) 42. 64000 .
43. Tax on amount on line 42 (Tax Table page 52) 43. 2045 .
44. Credit For Income Taxes Paid to Other Jurisdictions (Enclose Schedule NJ-COJ) (See instructions) 44. .
Enter Code
45. Balance of Tax (Subtract line 44 from line 43) 45. 2045 .
46. Sheltered Workshop Tax Credit 46. .
47. Gold Star Family Counseling Credit (See instructions) 47. .
48. Credit for Employer of Organ/Bone Marrow Donor (See instructions) 48. .
49. Total Credits (Add lines 46 through 48) 49. 0 .
50. Balance of Tax After Credits (Subtract line 49 from line 45) If zero or less, make no entry 50. 2045 .
51. Use Tax Due on Internet, Mail-Order, or Other Out-of-State Purchases (See instructions) If no Use Tax, enter 0 51. .
52. Interest on Underpayment of Estimated Tax 52. .
Fill in if Form NJ-2210 is enclosed
53. Shared Responsibility Payment (See instructions) REQUIRED Enclose Schedule HCC and fill in 53. .
 Name(s) as shown on Form NJ-1040
XX XX XX XX XX
FLEMING XX XX XX XX
WILLIAM R XX XX XX XX XX XX XX XX XX XX XX

Your Social Security Number

NJ-1040 140402832 N900
2022
Page 4

54. Total Tax Due (Add lines 50 through 53) 54. 2045 .
55. Total NJ Income Tax Withheld (Enclose Forms W-2 and 1099) (Part year, see instructions) 55. 35000 .
56. Property Tax Credit (See instructions page 24) 56. .
57. New Jersey Estimated Tax Payments/Credit from 2021 tax return 57. .
58. New Jersey Earned Income Tax Credit (See instructions) 58. .
Fill in if you had the IRS calculate your federal earned income credit
Fill in if you are a CU couple claiming the NJ Earned Income Tax Credit
59. Excess New Jersey UI/WF/SWF Withheld (Enclose Form NJ-2450) (See instructions) 59. .
60. Excess New Jersey Disability Insurance Withheld (Enclose Form NJ-2450) (See instructions) 60. .
61. Excess New Jersey Family Leave Insurance Withheld (Enclose Form NJ-2450) (See instructions) 61. .
62. Wounded Warrior Caregivers Credit (See instructions) 62. .
63. Pass-Through Business Alternative Income Tax Credit (See instructions) 63. .
64. Child and Dependent Care Credit (See instructions) 64. .
Fill in if you are a CU couple claiming the Child and Dependent Care Credit
65. New Jersey Child Tax Credit (See instructions) 65. .
Number of dependents under age 6 on 12/31/2022
66. Total Withholdings, Credits, and Payments (Add lines 55 through 65) 66. 35000 .
67. If line 66 is less than line 54, you have tax due. Subtract line 66 from line 54 and enter the amount you owe 67. .
If you owe tax, you can still make a donation on lines 70 through 77.
68. If the total on line 66 is more than line 54, you have an overpayment. Subtract line 54 from line 66 and enter the overpayment 68. 32955 .
69. Amount from line 68 you want to credit to your 2023 tax 69. .
70. Contribution to N.J. Endangered Wildlife Fund 70. .
71. Contribution to N.J. Children’s Trust Fund to Prevent Child Abuse 71. .
72. Contribution to N.J. Vietnam Veterans’ Memorial Fund 72. .
73. Contribution to N.J. Breast Cancer Research Fund 73. .
74. Contribution to U.S.S. New Jersey Educational Museum Fund 74. .
75. Other Designated Contribution (See instructions) Enter Code 75. .
76. Other Designated Contribution (See instructions) Enter Code 76. .
77. Other Designated Contribution (See instructions) Enter Code 77. .
78. Total Adjustments to Tax Due/Overpayment amount (Add lines 69 through 77) 78. 0 .
79. Balance due (If line 67 is more than zero, add line 67 and line 78) 79. .
80. Refund amount (If line 68 is more than zero, subtract line 78 from line 68) 80. 32955 .

Under penalties of perjury, I declare that I have examined this Income Tax return, including accompanying schedules and statements, and to Tax Due Address
the best of my knowledge and belief, it is true, correct, and complete. If prepared by a person other than the taxpayer, this declaration is Enclose payment along with the NJ-1040-V payment
voucher and tax return. Use the labels provided with the
based on all information of which the preparer has any knowledge.
envelope and mail to:
State of New Jersey
WILLIAM R FLEMING 11/15/2023 Division of Taxation
Revenue Processing Center - Payments
Your Signature Date Spouse’s/CU Partner’s Signature (required if filing jointly) Date PO Box 111
Trenton, NJ 08645-0111
Include Social Security number and make check or
Paid Preparer's Signature Federal Identification Number money order payable to:
State of New Jersey – TGI
You can also make a payment on our website:
nj.gov/taxation
WRF Refund or No Tax Due Address
Use the labels provided with the envelope and mail to:
Firm's Name Firm’s Federal Employer Identification Number
New Jersey Division of Taxation
Revenue Processing Center - Refunds
PO Box 555
NAVINTA Trenton, NJ 08647-0555

3 Division Use: 1 _______________ 2 _______________ 3 _______________ 4 _______________ 5 _______________ 6 _______________ 7 _______________

4
5
 If your income on line 29 is above the filing threshold, you
REQUIRED must submit this schedule with your return.

Name(s) as shown on Form NJ-1040 Social Security Number

FLEMING WILLIAM R 140402832

Schedule NJ-HCC Health Care Coverage 2022
If your income on line 29 is at or below the filing threshold (see instructions), do not complete this schedule.
Part I

Did you and, if applicable, all members of your tax household, have minimum essential health coverage for every month in
2022? (See instructions for line 53, NJ-1040.) Part-year residents include only months as a New Jersey resident.
X Yes. You do not owe a shared responsibility payment. Fill in the oval at line 53, NJ-1040, and enclose this
schedule with your return.
No. Continue to Part II.

Part II
Enter the name and Social Security number for each member of your tax household. Check the box for every month each
person had minimum essential health coverage or qualified for an exemption (part-year residents include only months as a New
Jersey resident). If an individual qualified for an exemption, enter the exemption number. (See instructions for line 53, NJ-1040.)
If an individual has more than one exemption number, check the box. If you need more space, enclose a statement listing any
additional individuals.
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Name Social Security Number

Exemption number: Check box if this individual has more than one exemption number

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Name Social Security Number

Exemption number: Check box if this individual has more than one exemption number

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Name Social Security Number

Exemption number: Check box if this individual has more than one exemption number

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Name Social Security Number

Exemption number: Check box if this individual has more than one exemption number

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Name Social Security Number

Exemption number: Check box if this individual has more than one exemption number

Keep a copy of this schedule for your records

 a Employee’s social security number
22222 140402832 OMB No. 1545-0008
b Employer identification number (EIN) 1 Wages, tips, other compensation 2 Federal income tax withheld
030437063 65,000 35,000
c Employer’s name, address, and ZIP code 3 Social security wages 4 Social security tax withheld
NAVINTA, 1499 LOWER FERRY ROAD, EWING NJ 08618
5 Medicare wages and tips 6 Medicare tax withheld

7 Social security tips 8 Allocated tips

d Control number 9 10 Dependent care benefits

e Employee’s first name and initial Last name Suff. 11 Nonqualified plans 12a
C
o
William R Fleming d
e

13 Statutory Retirement Third-party 12b

employee plan sick pay C
o
d
e

14 Other 12c
C
629 A ROSEMONT RINGOES RD, SERGEANTSVILLE NJ o
d
e
08557
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 18 Local wages, tips, etc. 19 Local income tax 20 Locality name
NJ M65097406503885 65,000 35,000

Form W-2 Wage and Tax Statement

Copy 1—For State, City, or Local Tax Department
2022 Department of the Treasury—Internal Revenue Service