Form NJ-1080C Nonresident Composite Return and Schedules A, B and C

Address Address Address Address Address Address Address Address Address Address City Address City ID Number ID Number State State State State State State State State State State Zip Code Zip Code Zip Code Zip Code Zip Code Zip Code Zip Code Zip Code Zip Code Zip Code Division For Tax Year January 1 December 31 2012 Legal name as shown on Form NJ 1080 C Legal name as shown on Form NJ 1080 C List all nonparticipants including principal address Add additional sheets as necessary List all participants including principal address Add additional sheets as necessary NJ 1080C NJ Income Tax NJ Income Tax NJ Income Tax NJ Income Tax NJ Income Tax NJ Income Tax SCHEDULE A PARTICIPANT DIRECTORY Total Income Less Than $250 000 See instructions on page 7 for the diskette requirements SCHEDULE B PARTICIPANT DIRECTORY Total Income Greater Than or Equal to $250 000 See instructions on page 7 for the diskette requirements SCHEDULE C NONPARTICIPANT DIRECTORY See instructions on page 7 for the diskette requirements Social Security Number or EIN Social Security Number or EIN Social Security Number or EIN Social Security Number or EIN Social Security Number or EIN Social Security Number or EIN Social Security Number or EIN Social Security Number or EIN Social Security Number or EIN Social Security Number or EIN STATE OF NEW JERSEY INCOME TAX NONRESIDENT COMPOSITE RETURN Taxable Income Taxable Income Taxable Income Taxable Income Taxable Income Taxable Income Taxable Income Taxable Income Taxable Income Taxable Income Total Taxable Income This Page Additional Pages Attached Total Taxable Income All Pages (Carry to Line 17 Column A) Total NJ Income Tax This Page Additional Pages Attached Total NJ Income Tax All Pages (Carry to Line 18 Column A) Total Taxable Income This Page Additional Pages Attached Total Taxable Income All Pages (Carry to Line 17 Column B) Total NJ Income Tax This Page Additional Pages Attached Total NJ Income Tax All Pages (Carry to Line 18 Column B) Use 1 2 3 4 5 6 7