Form D-400 - Individual Income Tax Return - 2014 Page 3
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4D-400
Individual Income
Web
9-14
Tax Return 2014
Print in Black or Blue Ink Only. No Pencil or Red Ink.
1 4
For calendar year 2014, or fiscal year beginning
and ending
(MM-DD)
(MM-DD-YY)
Your Social Security Number
Spouse’s Social Security Number
You must enter your
social security number(s)
Your First Name
M.I.
Your Last Name
(USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS)
If a Joint Return, Spouse’s First Name
M.I.
Spouse’s Last Name
Mailing Address
Apartment Number
City
State
Zip Code
Country (If not U.S.)
County
(Enter first five letters)
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.
Fill in circle if you or your spouse were out of the country on April 15 and a U.S. citizen or resident.
Deceased Taxpayer Information
Fill in circle if return is filed and signed by Executor, Administrator or Court-Appointed Personal Representative.
Taxpayer
Spouse
(MM-DD-YY)
(MM-DD-YY)
Enter date of death of deceased taxpayer or deceased spouse.
If No, complete Lines 1 through 12. Then go to
Were you a resident of N.C. for the entire year of 2014?
Yes
No
Residency Status
Part D of Schedule S. Fill in residency information
Was your spouse a resident for the entire year?
Yes
No
and complete Lines 20 through 22.
Filing Status
IMPORTANT: Do not send a photocopy of this form.
Fill in one circle only. (See instructions on Page 8)
The original form is printed in pink and black ink.
1.
Single
2.
Married Filing Jointly
Name
(Enter your spouse’s
3.
Married Filing Separately
full name and Social
Security Number)
SSN
4.
Head of Household
5.
Qualifying Widow(er) with Dependent Child
)
(Year spouse died:
Enter Whole U.S. Dollars Only
,
,
.
6. Federal adjusted gross income
6.
(Form 1040, Line 37; Form 1040A, Line 21; or Form
00
1040EZ, Line 4) (If negative, see the Line instructions)
If amount on
Line 6, 8, 10,
,
,
.
7. Additions to federal adjusted gross income
12, or 14 is
(From Part A of Form D-400 Schedule S, Line 4;
7.
00
negative, fill in
attach Schedule S if additions are reported.)
,
,
.
circle.
8. Add Lines 6 and 7
8.
00
Example:
,
,
.
9. Deductions from federal adjusted gross income
9.
(From Part B of Form D-400 Schedule S, Line 12;
00
attach Schedule S if deductions are reported.)
,
,
.
10. Subtract Line 9 from Line 8
10.
00
11. N.C. standard deduction OR itemized deductions (See instructions on Page 8)
,
,
.
If itemizing, complete Part C of Form
11.
00
If you claimed the standard
D-400 Schedule S and enter the amount
deduction on federal
from Line 19; attach Schedule S.
,
,
.
form 1040, fill in circle
12.
00
12.
Subtract Line 11 from Line 10
.
13.
Part-year residents and nonresidents
(From Part D of Form D-400 Schedule S, Line 22;
13.
attach Schedule S if a part-year resident or nonresident)
14.
North Carolina Taxable Income
,
,
.
Full-year residents enter the amount from Line 12
14.
00
Part-year residents and nonresidents multiply amount on Line 12 by the
decimal amount on Line 13
,
,
.
15. North Carolina Income Tax
15.
To calculate your tax, multiply your North Carolina Taxable Income
00
Line 14 by 5.8% (0.058)
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