D-400 - Individual Income Tax Return 2014
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1
2D-400
Individual Income Tax Return 2014
(27)
11-24-14
<
North Carolina Department of Revenue
Staple All Pages of Your
Return and W-2s Here
14
For calendar year 2014, or fiscal year beginning
and ending
Select box if you or your spouse were
out of the country on April 15 and a
U.S. citizen or resident.
Select box if return is filed and signed
by Executor or Administrator.
Your SSN:
Spouse’s SSN:
Filing Status
1. Single
2. Married Filing Jointly
3. Married Filing Separately
4. Head of Household
5. Widow(er) with Dependent Child
You Spouse
Year spouse died:
Return for deceased taxpayer
Date of death:
Select box if you or your spouse were a nonresident of NC for the entire year.
Return for deceased spouse
Date of death:
Select box if you or your spouse moved into or out of NC during the year.
N.C. Education Endowment Fund: You may contribute to the N.C. Education Endowment Fund by making a contribution or designating some or all of
your overpayment to the Fund. To make a contribution, enclose Form NC-EDU and your payment of
$
.
To designate your overpayment
to the Fund, enter the amount of your designation on Page 2, Line 28. See instructions for information about the Fund.
N
N
FS
PP
DT
OC
TD
DS
EA
N
SD
0
06
18
23B
0
07
18
23C
20A
0
09
23E
11
20B
EU
11
21A
24
00000
21B
13
26
0
21C
14
27
21D
0
15
28
23A
16
30
TN
PN
PP
Sign Return Below
Refund Due
Payment Due
If prepared by a person other than taxpayer, this certification is based on all information of
I certify that, to the best of my knowledge, this return is accurate and complete.
which the preparer has any knowledge.
Your Signature
Date
Spouse’s Signature (If filing joint return, both must sign.)
Date
Paid Preparer’s Signature
Date
Home Telephone Number (Include area code)
Paid Preparer’s FEIN, SSN, or PTIN
Paid Preparer’s Telephone Number
If you ARE NOT due a refund, mail return, any payment, and Form D-400V to: NCDOR, P.O. Box 25000, Raleigh, N.C. 27640-0640
If REFUND mail to: NCDOR, P.O. Box R, Raleigh, N.C. 27634-0001
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