Form Nj-2450 - Employee'S Claim For Credit - 2010 printable pdf download

EMPLOYEE’S CLAIM FOR CREDIT

NJ-2450

FOR EXCESS UI/WF/SWF, DISABILITY INSURANCE, AND/OR

FAMILY LEAVE INSURANCE CONTRIBUTIONS FOR CALENDAR YEAR 2010

Claimant Social Security No.

Name:

Note on Joint NJ-1040 Return:

Address:

Each spouse/CU partner must file a separate

form when claiming a refund for excess

contributions.

City, State, Zip Code:

To establish a right to this credit, claimants are required to complete the items below (information is to be transcribed from W-2 forms enclosed with

your New Jersey State Income Tax return). Any items not substantiated by a W-2 or any information that is incomplete will cause the claim to be

rejected. The amount withheld for the Unemployment Insurance/Workforce Development/Supplemental Workforce Funds, disability insurance, and

the amount of Family Leave Insurance withheld must be reported separately on all W-2 statements.

TAKE ALL INFORMATION FROM YOUR W-2 FORMS.

COLUMN A

COLUMN B

COLUMN C

If the amount deducted by any one employer exceeds the maximum for either

FAMILY

UI/WF/SWF

DISABILITY

UI/WF/SWF, disability insurance, or Family Leave Insurance, insert the maximum in

LEAVE

DEDUCTED

INSURANCE

the appropriate Column(s) and contact that employer for a refund of the balance of the

INSURANCE

DEDUCTED

deduction.

DEDUCTED

1A. Employer’s Name:

Fed. Emp. I.D. #:

Private Plan #:

Wages:

B. Employer’s Name:

Fed. Emp. I.D. #:

Private Plan #:

Wages:

C. Employer’s Name:

Fed. Emp. I.D. #:

Private Plan #:

Wages:

D. Employer’s Name:

Fed. Emp. I.D. #:

Private Plan #:

Wages:

E. Employer’s Name:

Fed. Emp. I.D. #:

Private Plan #:

Wages:

F. Employer’s Name:

Fed. Emp. I.D. #:

Private Plan #:

Wages:

*If additional space is required, enclose a rider and enter the total on this line

Total Deducted: Add Lines 1A through 1G. Enter here.

126.22

148.50

35.64

Correct UI/WF/SWF, Disability Insurance, and/or Family Leave Deductions

Deduct Line 3 Col. A from Line 2 Col. A. Enter on Page 3, Line 51 of the NJ-1040.

Deduct Line 3 Col. B from Line 2 Col. B. Enter on Page 3, Line 52 of the NJ-1040.

6. Deduct Line 3 Col. C from Line 2 Col. C. Enter on Page 3, Line 53 of the NJ-1040

I hereby apply for a credit for worker contributions deducted in excess of $126.22 for N.J. UI/WF/SWF and/or in excess of $148.50 for NJ Disability

Insurance and/or in excess of $35.64 for NJ Family Leave Insurance deductions by reason of having received wages from two or more employers during

the above calendar year and hereby submit the following statement of wages and deductions.

Claimant’s Signature: ______________________________________________________________ Date: _________________________________

Form Nj-2450 - Employee'S Claim For Credit - 2010

Related Articles

Related forms

Related Categories