Income Tax

OMS No. 1545-0008

OMS

a Control number

1 Wages, tips, other compensation

2 Federal income tax withheld

120227 39

26492.36

3 Social securitywages 90000.00 5 Medicarewages and tips 130141 17

4 Social securitytax withheld 5579.36 6 Medicaretax withheld

645613

.

11 Wages, tips, other compensation

90000.0 ]l'

865 STONE STREET

7 Social security tips

8 Allocated tips

9 Advance EIC payment

10 Dependent care benefits

11 Nonqualified plans

c12a

lE

c12c

3 c12d 3

44

07065 221487305000

JERSEY

UIDI

!

22 -1487305 --'Other SI [ 124.50 UNEM 99.61 \lIDPF 6.23

1887.05

, c Employer'sname, address, and ZIPcode RWJUH AT RAHNAY 186 IRAIlfAY, NEW

c12b

5579.36 6 Medicare tax withheld

130

i

b. Employeridentificationnumber

26492.36 4 Social security tax wijhheld

5 Medicare wages and tips

180

I

12 Federal income tax withheld

120227

I

3 Social security wages

c Employer's name, address, and ZIP code

e Employee'sname, address, and Zip code LUZ NERCADO 32 WOODVIEW AVENUE NJ FORDS,

1545-0008

5613

1887 05

RW.JUHAT RAIlfAY 186 865 STONE STREET RAIlfAY, NEW JERSEY 07065 UIDI 221487305000

No.

a Control number

7 Social securitytips"

8 Allocatedtips

9 Advance EICpayment

10 Dependent care benefits

11 Nonqualifiedplans

c12a 3C c12b

16 b. Employer identification number

I

9913

78

22-1487305 14Other SDI 124.50

I I

3E c12c

I

s

I

3 c12d

UNEN '99.61

\llDPF 6.23

I

44

16

9913 78

I

e Employee'sname, address, and Zip code LUZ NERCADO

00628 I

08863

32

AVENUE

IfOODVIEW

NJ

FORDS,

d Employee social securijy number

08863

d Employee social securijy number

Third-party siCk pay

135-84-2049

200S 15 State Employer's state 1.0. no. 315665001 Wage and Tax 17 Stateincometax ~ .2W - 2 Statement 6755 Copy 2 for EMPLOYEE'S State, City, or Local Income Tax Return

131811.67

19 Localincometax

18 local wages, tips, etc.

18 Local wages. tips,

20 Locality name

20

Department of the Treasu~nternal

Revenue Service

Department

name

Treasury-Internal

Revenue

Service

OMS No. 1545.0008

OMS No. 1545-0008

a Control number

of the

Locality

etc.

11 Wages, tips, other compensation

a Control number

12 Federal income tax withheld

11 Wages, tips, other compensation

645613

645613

I

3 Social security wages

26492.36 4 Social security tax withheld 5579.36 6 Medicaretax withheld

3 Social security wages

5579.36

90000.00

90000.00

6 Medicare tax withheld

5 Medicare wages and tips

c Employer'sname, address, and ZIPcode 186 RW.JUH AT RAIlfAY 865 STONE STREET 07065 RAIlfAY, NEW JERSEY UIDI 221487305000 7 Social security tips

8 Allocated tips

10 Dependent care benefits

11 Nonqualified plans

5 Medicare wages and tips

2

1887.05

130141.17

130141.17

/'

RWJUH AT RAIlfAY R86 865 STONE STREET

RAIlfAY, NEW JERSEY

07065

UIDI 221487305000

14Other SI I 124 .50 UN EN 99.61 \lIDPF 6.23

7 Social security tips

8 Allocated tips

9 Advance EIC payment

12a See instructions for box 12

10 Dependent care benefits

11 Nonqualified plans

12a See instructions for box 12

I

C I

44.16

I

9913.78

12c

I 12d

I

e Employee'sname, address, and Zip code LUZ NERCADO 32 NOODVIEW AVENUE

b. Employeridentificationnumber 22-1487305

12b

14Other SDI 124 .50 UNEN 99.61 \llDPF 6.23

12c

E

44.16 9913.78

I

I 12d

.

I

e Employee's name, address, and Zip code

00628

LUZ NERCADO 32

NJ

08863

IfOODVIEW

AVENUE

FORDS,

siCk

08863

NJ

d Employee social security number

Third-party pay

135-84-2049 16 State wages,

tips,

200S J.:: State Employer's state1.0.no. 315665001

etc.

131811.67 17

State

income

18

tax

Local

wages,

tips,

Wage and Tax

etc.

6755.68 19

Local

income

20 Locality name

tax

gW 2 ~ - Statement

17 Stateincometax

Copy C For EMPLOYEE'S RECORDS

19 Locatincometax

. information

is

being

furnished

to the Internal Revenue

r

information

required

II

wages,

lips, etc.

20

Locality

name

DepartmenloftheTreasury-lntemal Revenue' This

Service

18 Local

6755.68

DepartmentoftheTreasury-lnlernal RevenueService This

I

9 Advance EIC payment

12b

b. Employeridentificationnumber -1487305

I

1887.05

c Employer's name, address, and ZIP code

180

rc

FORDS,

12 Federal income tax withheld

120227.39

to

is being

file a tax

furnished

return,

to the

a negligence

on you ifthisincome istaxable

Internal

penalty

Revenue or other

andyoufail toreport it.

Service. sanction

If you

may

be

are imposed

(See

Notice

to

onback of C1

I

--

I

Form

1040X

Department of the Treasury ~ Internal Revenue Service

Amended U.S. Individual Income Tax Return

(Rev November 2005)

~

----

--------

-

.

.

___ ___n

2005 - - - -

- ---

1

-. -- - -

Your first name

_ __

OMS No. 1545-0074

See separate instructions. ended ded

,

MI

last name

Your social security number

MI

last name

Spouse's social security number

LUZ R. MERCADO

135-84-2049

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 AVENUE

Phonenumber

Apt no.

732-499-6117 State ZIP code

City, townor postoffice.If you havea foreignaddress,see instructions.

For PaperworkReduction Act Notice, see instructions.

FORDS, NJ 08863 A

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, check

B

here.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _. . . . . . . . .

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

D D

D D

Single

Married filing jointly

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

D D

Married filing separately

Tax Lia.

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

1 2

Adjusted

3 4 5 6

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

7 8

gross income

(see

previously adjusted (see instructions) 1

Head of household.

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

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

Sign Here rceep a copy or your records.

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

6

12,298.

7

Use Only BAA

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

-3,200. 3,200.

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

16 17 18

26,492

19 20 21 22 23

14,194. 12,298.

'I

1

.

N

I

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 bestofmyknowledgeand belief,thISamendedreturnis true,correct,and complete.Declarationof preparer(0 er thantaxpayer)is based on all informationof whichthe preparer has any knowledge.

I signature Firm's name

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

I

Date

Yoursignature

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

Date

Date

Preparer's

Paid Preparer's

Qualifying widow(er)

105,367.

I I

Joint retum? See instrs.

Qualifying widow(er)

C Correct amount

or (decrease) explain in Part II

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

D D

105,367.

2 3 4 5

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

Head of household

B Net change amount of increase

A Original

amount or as

Use Part II on page 2 to explain any changes

Income and Deductions

~ ~

Married filing separately

JACK KAPLAN,

EA

;1yJe.lf:

I :

21E_n________________________ 9grgy____________________ Avenel,

NJ

07001

IX]

EIN

I

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

Phoneno. FDIA1812l

12/02/05

(732)

602-9010

Form 1040X (Rev 11-2005)

I

LUZ R. MERCADO Parl1U:1j Exemptions. See Form 1040 or 1040A instructions.

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

135-84-2049

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

· ·individualsdisplacedby HurricaneKatrina.

25 Yourselfand spouse

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

A Original number of exemptions reported or as previously adjusted

C Correct number of exemptions

B Net change

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

Page 2

1

4

-1

3

1 6

-1

1 5

Your dependent children who did not live with you due to divorce or separation. . . . . .

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

.

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 . . . . . . . . . ..

~

19,200.

-3,200.

16,000.

19,200.

-3,200.

16,000.

~

I32

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 (see instructions)..

~

D D

Dependents on 33 not entered above ~

Explanation of Changes Enter 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 that shows the year in which

the loss or credit occurred.

DEPENDENT ANNALIZA

PartIII If you

did not

See the instructions.

Also, check here.

MERCADO WAS DELETED FROM ORIGINAL

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

~

RETURN

Presidential Election Cam ai n Fund. Checkin previously

want

$3 to go to the

fund

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

but

now

want

to, check

Form

FDIA1812L

12102105

~

~

1040X (Rev 11-2005)

I

SCHEDULE A

OMS No. 1545-0074

Itemized Deductions

2005

(Form 1040) ~

Department of the Treasury Internal Revenue Service

(99)

~

Attach to Form 1040.

See Instructions

for Schedule

Attachme, " Sequence-,No.

1040).

A (Form

Name(s) shown on Form 1040

Your social security

07

number

LUZ R. MERCADO Medical and Dental Expenses

Caution. Do not include expenses reimbursed or paid by others. and dental expenses (see instructions).

1

Medical

2

Enteramount fromForm1040,line3& . . . ..

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

~

U

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):

Taxes You Paid

a b

~ Incometaxes, or D

J

(See

6 7

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

instructions.)

8

Other

Interest You Paid

5,987.

1

taxes.

List

type

and

amount

o.

6,986.

5

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

4

_ __ _ _ _ _ __ _ _ _

~

8 ,9 Addlhles5through-8~~ ~ ~ ~ ~.~~ .~.-:.-:.-:.-:.-:.-:.-:.-:.-:.-:.-:.~ 10 Home mtginterest andpointsreported toyouonForm1098 Se.e.St.1 10 11 Homemortgage interestnotreportedto youonForm1098. If paidto theperson

.1 9

12,973.

14 Add lines 10 through 13.. .. .. .. .. .. .. .. .. .. .. . .. .. .. .. . .. .. . . .. . . .. .. .. .. . .. .. . .. .. .. .. .. I 14

15,617.

15,437.

from whom you boughtthe home, see instructions and showthat person'sname, identifying number, and address ~

(See

----------------------------------------------------------------------------------------

instructions.)

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

12 POlntSn-;;-t re~rt~toyo~ ~ Fo~ 1098:S; ;nstrsfo~spcl~u~s-:-.-:Stult. _:_2112 I 13 Investmentinterest. Attach Form 4952 if required. (See

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

15a 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).. .. .. .. ...

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

17

Carryover

..

W

31 15al

2,200.

~

16

over$50D. .. ... ... ..

180.

..

... .. .. ..

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

I 16 m

0

18 Addlines15a,16,& 17................................................................... Casualty and Theft Losses Job Expenses and Certain Miscellaneous Deductions

(See instructions.)

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.) ~ --------------

----------------------------------------------------------21 22

Tax

preparation

fees.

type

and

o.

amount

~

_ __ _ _ __ _ _ __ _ _ _ _ __ _ _ _ 3,539.

23 Add lines 20 through 22. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,749. 24 EnteramountfromForm1040,line38. . . .. 24 105, 367 25 Multiplyline24by2%(.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 ~ _ _ _ _ __ _ _ _ _ __ __ _

,

.

1,642.

-------------------------------------------27

o.

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

BAA

19 I

210.

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

.

Total Itemized Deductions

2,200.

Other expenses - investment, safe deposit box, etc. List

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

Other Miscellaneous Deductions

i181

For Paperwork

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 YOUelect to itemize deductionseyenthouahthey are less than your standarddeduction.check here ~

Reduction Act Notice, see Form 1040 instructions.

FDIA0301L

11/18/05

Schedule A (Form 1040) 20D5

I

Form

6251

OMS No. 1545-0074

Alternative MinimumTax - Individuals

(Rev January 2006) Department of the Treasury Internal Revenue Service

~

(99)

2005

~ See separate instructions. Attach to Fonn 1040 or Form 1040NR.

Attachment Sequence No.

Yoursocial

Name(s) shown on Form 1040

32

security number

See instructions for how to com

2

If 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.. . .

3

Taxes

4 5

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

1 2 3 4 5

6

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

6 7

Investment interest expense (difference between regular tax and AMT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8

7 8

from

Schedule

A (Form

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

1040),

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

. . . . . . . . . . . . .. . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . 9 10 Net operating loss deduction from Form 1040, line 21. Enter as a positive amount.. 10 9

Depletion

(difference

between

regular

tax and AMT)

11 12 13 14 15

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) . .. . . . . . . . . . . . . . . .. . . . . .. . . ..

16

Disposition

17

Depreciation on assets placed in service after 1986 (difference between regular tax and AMT). .. .. ..

17

18

Passive

18

19

Loss limitations

20

Circulation

costs (difference

21

Long-term

contracts

22

Mining

23

Research

24

Income from certain

25

Intangible

26

Other adjustments,

27

Alternative

of property

activities

costs

(difference

(difference (difference

between

tax gain or loss)

tax income

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

or loss) . . . . . . . . . . . . . . . _. . . . . . . . . . . . . . .. . . .. . . . . . . .. . . . . , . . . . . . . . . .. .. ..

19

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

20

between regular

AMT and regular tax and

AMT)

between

sales before January

costs preference. including

AMT and regular

costs (difference

installment

tax net operating

AMT and regular

AMT and regular tax income

between

between

and experimental

drilling

between

(difference

(difference

between

or loss)..

tax income).

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

21

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

22

regular

tax and AMT). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..

24

. . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..

25

income-based

related

loss deduction.

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

26

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

adjustments.

27

is more than $191,000, see instructions.),

29

I Alternative

23

1, 1987. . . .. . . . . . . .. . . .. . . . . . . . . . . . . . . . . . . . . . . .. . . ..

28 Alternative minimum taxable income. Combine lines 1 through 27. (If married filing separately and line 28

~artU

11 12 13 14 15

87,550.

1 28

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

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.

line 29

$40,250

...

}

.... ...

40,250.

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

47,300.

30

Subtract

31

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

58,000 29,000

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

}

32

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

33

Tentative

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 refigured

-

without

minimum

tax.

using Schedule

Subtract

line

32 from

J (see instructions).

line

12,298.

J

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

33

I

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341

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. FDIA5312L01113/06

35

12,298.

9,729. 2,569.

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 Beginning

,

T A

x

p A Y E R

,

You must enter your social security number below YourSocialSecurityNumber

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

MERCADO

Spouse'sSocialSecurityNumber

Homeaddress(Numberand Street,includingapartmentnumberor rural route)

County/Municipality Code

City,Town,Post Office

32

I

0

N A N

D s T A T u

WOODVIEW

FORDS,

D E N T I F I c A T I

AVENUE State

FILING STATUS

From

1

ON

_

-

2 -

to MONTH DAY YEAR

MONTH DAY YEAR

As Originally Reported

EXEMPTIONS

U

7 Age 65 or Over

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

7 8

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

9

6 Regular

ORIGINALAMENDED RETURN RETURN Single Married,filingjointreturn

6

10 3 11 11 Dependents attending colleges. . . . . . .. .. . . . . .. . _ Married,filing separatereturn 4 X X Headofhousehold 12Totals (ForLine12a- AddLines6,7,8,and11).. ... .. 12a s 5 Qualifyingwidow(er) (For Line 12b - Add Line 9 and Line 10)... . . . .. . 12b 13 GUBERNATORIALELECTIONSFUND Checkingbelow will not increaseyour tax or reduceyour refund.

-

10Number of other dependents. . . . . . . . .. .. . . . . .. .

-

Checkhere--Checkhere---

14 Wages,salaries,tips, and other employee compensation. 15a Taxable Interest Income.. xLr:T

Amended

1

1

4

3

1

1

1 5

1 4

R If you not and previouslywant have $1 go to the fund but $1 now to do so.but now wants it to do so. jointdid return if spousedidtonot previouslywant to have towant go toitthe fund Amended (See Instructions) '0'

As Originally Reported

15 b

ZIP Code

NJ 08863

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

ON

- Enterspouselast nameONLYifdifferent)

LUZ R.

135-84-2049

.i

. . . . . . . . . . . . . . . . . . . . . . . . 14 .. ...... . . .. ...... .... . 15a : .?

.:.

i.I.

.....

".

131,812 18

r

*

Ii!

[

131,812

18

"I '

15b

I

!J

16 Dividends.. .. . . . . . . . . .. . . .. . . .. .. . . . . .. . . . . . . . . . 16 17 Net profits from business. . . . . . . . . . . . . . . . . . . . . . . . 17

@

18 Net gains or income from disposition of property.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 a TaxableAmount Received... 19a

19 Pensions,Annuities

b Less New Jersey Pension Exclusion.

..........

;

:

and IRA Withdrawals

' .1

19b

tI

c Subtract Line 19b from Line

19a

20 Distributive Share of Partnership Income. . . . . . . . . . 21 Net pro rata share of S Corporation Income. . . . . . .

20 21

22 Net gain or income from rents, royalties, patents and copyrights. . .. .. . . . . .. . . . . . . .. .. .. .. . 23 Net GamblingWinnings... .. ....... ..............

22 23 24

25

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

25

received.

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

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

",'.

@

.TI,

::

, @

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

payments

pc

. . . . . . . . . . . . . . . . . . . . 19c

24 Alimony and separate maintenance

$I

@

TI

..@ pI1

if

@ E

26

131,830 NJIA0412L

12129/05

III

;11

,

@

..

4

"*

131,830

I

I

LUZ R. MERCADO

-'135-84-2049 Amended

As Originally 27 28 29 30 31 32 33 34 35 36 37 38 39

Reported 131

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)...... 38

40 41

TAX: (see instructions). . .. .. .. .. . . . . .. .. . . . . ... . . . .. .. . . .. .. . . . . . . .. . 39 Credit For Income Taxes Paid To Other Jurisdictions.. ......... . ....... 40 Balance of Tax (Subtract Line 40 from Line 39). . . . . . . . . . . . . . . . . . . . . . . . 41

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

830

Page - 2

(See Instructions) 131 830

"

131 830 8.500

131 830 7 000 "

8.500 123 330 5.987 117 343 3 708

7 124 5 118 3

000 830 987 843 791

'.'.

i

3 708

3791

.....

3 708 6.756

3 791 6 756 '" 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 request for extension

51 52 53 54 55 56

to file. .. . . .. .. . . . . .. . . . . . . . . . . .. . . . . .. . . . . . . . . . . . . .. . . .

Total payments

(Add Lines 44 through

50}

50

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

6.756 3 048 3.708

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

6 756 3 048 3.708 83

:1 Net Payments(SubtractLine 52 from Line 51).... .... .. .. ........ . ... . 53 OFTAXYOUOWE... .. .... .. .. .... 54 If payments(Line 53) are LESSTHANtax (Line43) enter AMOUNT 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.. .. .. .. .. .. .. . .. .. .. . .. .. .. .. .. .. .. .. .. .. .. 56B Enterbelow,name,socialsecuritynumber,and addressas shownon orinal return(if sameas indicatedon page I, write'Same').If changingfrom separateto joint return,enter names, socialsecuritynumbers,and addressesusedon originalreturns. (Note: ou cannotchangefrom jointto separatereturnsafterthe duedate has passedunlessyou havedoneso for Federal tax purposes.)

Same Your SSN Spouse's SSN Enterlast name,first name,middleinitial, socialsecuritynumber,andbirth year of yourdependentswhowerenot claimedas dependentson originalreturn.

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)

=

X

(Income from New Jersev sources)

(NewJerseyTaxline 39)

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.

-

Date

Yoursignature SIGN HERE PaidPreparer'sSignature

-

Spouse'ssignature(If filing jointly,BOTHmustsign.) FederalEmployerIdentificationNumber

JACK KAPLAN, EA

POO022437

Firm'sName

FederalEmployerIdentificationNumber

Kaplan

& Bender

1030 St. Georges Avenel, Division Use

1

2

22-3761453

Ave.

NJ

-

Mail your return to: Divisionof Taxation RevenueProcessingCenter POBox 111 Trenton,NJ08645-0111

If Refund: Divisionof Taxation RevenueProcessingCenter PO Box555 Trenton,NJ 08647-0555 You may also pay bye-check orcreditcard.

07001 3

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

4

NJIA0412L

5

12/29/05

6

7