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Form Nj 1040x 2015
Number
Home address (Number and Street, incl. apt. # or rural route)
County/Municipality Code
City, Town, Post Office
NJ RESIDENCY
STATUS
If you were a New Jersey resident for ONLY part of the
taxable year, give the period of New Jersey residency:
ON
AMENDED
RETURN
1.
¨
¨
2.
¨
¨
3.
¨
¨
4.
¨
¨
5.
DEPENDENT INFORMATION
State
FILING STATUS
ON
ORIGINAL
RETURN
¨
¨
Change of Address
From _________________________
MONTH
DAY
YEAR
To...
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