Dependent Student Civil Union Worksheet
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1
2S
N
J
• H
E
S
A
A
TATE O
OF
EW
ERSEY
IGHER
DU
CATION
TUDEN
NT
SSISTANCE
E
UTHORITY
PO B
540 • T
, NJ 08625
5-0540
OX
X
RENTO
ON
To sub
bmit this form
m, visit
njgrants.org
then click on
n ‘Electronic D
Document Co
ollection’.
Dep
penden
nt Stude
ent Civi
il Union
n Works
sheet 2
015-20
16
A: Stu
udent’s Infor
rmation
__
___________
____________
___________
_______
__
____
_____
____________
___________
____________
_
1. Stude
ent’s name
First
t
M.I.
Last
2. Stude
ent’s
perman
nent
___
_______________
_______________
________________
_______________
_______________
________________
________________
_______________
__
mailing
address
Num
mber, street and apartme
ent number
(do not
give
college
e address)
___
_______________
_______________
__________
____
___
__________
_______
City
State
e
Zip Code
3. Stude
ent’s Social Sec
urity Number (S
SSN)
________
_ -- _____ -- __
_________
I
Is this a change
e in SS#?
Ye
es
No
(
(If “Yes”, attach
h a copy of the
SS# card.)
4. Date
of Civil Union:
MM / YY
Civil Un
nion Partner
Parent
B: Inc
come, Earni
ings and Be
enefits Infor
mation
5A.
5B.
1
.
1.
5. The fo
ollowing 2014 U
U.S. income
1. A complete
ed 2014 IRS Form
1040A or 1040EZ
2
.
2.
tax fi
gures are from
…
2. A complete
ed 2014 IRS Form
1040
3
.
3.
(Chec
ck only one box
x.)
3. An estimate
ed 2014 IRS Form
1040A or 1040EZ
4
.
4.
4. An estimate
ed 2014 IRS Form
1040
5
.
5.
5. A tax return
n will not be filed
6. 2014 total
number of exem
mptions
(IRS Form
m 1040-line 6d or 1040
0A-line 6d. Form 1040
0EZ
6A.
6B.
filers – use the
1040EZ line 5 worksh
eet & enter 00, 01,o
r 02 to equal each $
$3,950 exemption for
r
Which you qua
alify.)
7A.
7B.
$__
__________________
__.00
$___
__________________
_.00
7. 2014 adjust
ted gross incom
me
(IRS Form 1040-lin
ne 37, 1040A-line 21,
or 1040EZ-line 4)
8A.
8B.
$__
__________________
__.00
$___
__________________
_.00
8. 2014 U.S. in
come tax paid
(IRS Form 1040-line 5
56, 1040A-line 37, or
1040EZ-line 10.)
9A.
9B.
9. 2014
4 income earne
ed from work
$__
__________________
__.00
$___
__________________
_.00
10A.
10B.
$_
_________________
___.00
$___
__________________
_.00
10. 2014
4 untaxed inco
me
(student/civil u
union partner – FAFSA
A questions 45a-j)
11. 2014
4 untaxed Soci
al Security ben
efits
Whe
ere do I find untaxed
d Social Security ben
nefits? 2014 IRS form
1040-line 20a minus 2
20b; 2014 IRS form
11A.
11B.
$_
_________________
___.00
$___
__________________
_.00
1040
0A-line 14a-14b. If yo
ou are not required to
o file a federal incom
me tax return and yo
ou received Social S
Security
bene
efits, report the amo
ount shown on your 2
2014 form SSA-1099.
12. 2014
4 taxable Socia
al Security bene
efits
Whe
ere do I find taxable
Social Security bene
efits? 2014 IRS form 1
040-line 20b; 2014 IR
RS form 1040A-line 14
4b.
12A.
12B.
Ente
er zero “0” if you are
not required to file a
a 2014 federal incom
me tax return.
$_
_________________
___.00
$____
______ ___________
_.00
13. 2014
4 Unemployme
ent Compensati
ion
Whe
ere do I find Unemplo
oyment Compensati
ion? 2014 IRS form 10
040-line 19; 2014 IRS
form 1040a-line 13; 2
2014
IRS fo
orm1040EZ-line 3. If y
you are not required
to file a federal inco
ome tax return, or re
equired to file but ha
ave not
13A.
13B.
$_
_________________
___.00
$___
__________________
_.00
yet d
done so, enter the a
mount(s) found in b
ox #1 on the 2014 IR
RS Form(s) 1099-G
14. 2014
4 Earned Incom
me Tax Credit
Whe
ere do I find Earned I
ncome Tax Credit? 2
2014 IRS form 1040-li
ne 66a; 2014 IRS form
m 1040a-line 42a; 20
14
14A.
14B.
$_
_________________
___.00
$___
__________________
_.00
IRS fo
orm1040EZ-line 8a. If
f you are not require
d to file a federal inc
come tax return, ent
ter zero “0”.
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