Form D-400 - Individual Income Tax Return - 2014 (Page 4 of 4) in pdf

Page 2

Last Name (First 10 Characters)

Tax Year

Your Social Security Number

2014

D-400 Web

9-14

Be sure to sign and date your return below.

16. Tax Credits (From Form D-400TC, Part 3, Line 20 - You must attach

16.

Form D-400TC if you enter an amount on this line)

17.

Subtract Line 16 from Line 15

If you certify that no Consumer

18. Consumer Use Tax (See instructions on Page 9)

18.

Use Tax is due, fill in circle

19. Add Lines 17 and 18

19.

20.

North Carolina Income Tax Withheld

a. Your tax withheld

20a.

(Staple original or copy of the original State

wage and tax statement(s) in lower left-hand

corner of the return)

20b.

b. Spouse’s tax withheld

21.

Other Tax Payments

a. 2014 Estimated Tax

21a.

b. Paid with Extension

21b.

c. Partnership

21c.

If you claim a partnership payment on Line 21c

or S corporation payment on Line 21d, you must

attach a copy of the NC K-1.

d. S Corporation

21d.

22. Add Lines 20a through 21d and enter the total on Line 22

22.

23.

a. Tax Due - If Line 19 is more than Line 22, subtract and enter the result

23a.

b. Penalties

c. Interest

(Add Lines 23b

and 23c and

enter the total

23d.

on Line 23d)

e. Interest on the underpayment of estimated income tax

23e.

Exception to

(See Line instructions and enter letter in box, if applicable)

underpayment

of estimated

24.

Add Lines 23a, 23d, and 23e and enter the total

tax

24.

Pay This Amount - You can pay online. Go to

and click on Electronic Services for details.

25.

Overpayment - If Line 19 is less than Line 22,

25.

subtract and enter the result

26.

Amount of Line 25 to be applied to 2015 Estimated Income Tax

26.

27. Contribution to the N.C. Nongame and Endangered Wildlife Fund

27.

28.

Contribution of overpayment to the N.C. Education Endowment Fund

28.

29.

Add Lines 26, 27, and 28

29.

30.

Subtract Line 29 from Line 25 and enter the Amount To Be Refunded

30.

For direct deposit, file electronically. Go to and click on efile.

I certify that, to the best of my knowledge, this return is accurate and complete.

If prepared by a person other than taxpayer, this certification is based on all

information of which the preparer has any knowledge.

Your Signature

Date

Paid Preparer’s Signature

Date

Spouse’s Signature (If filing joint return, both must sign.)

Date

Preparer’s FEIN, SSN, or PTIN

Home Telephone Number (Include area code.)

Preparer’s Telephone Number (Include area code.)

N.C. DEPT. OF REVENUE

If you ARE NOT due a

N.C. DEPT. OF REVENUE

If REFUND mail

P.O. BOX R

refund, mail return, any

P.O. BOX 25000

return to:

RALEIGH, NC 27634-0001

payment, and D-400V to:

RALEIGH, NC 27640-0640

Form D-400 - Individual Income Tax Return - 2014 Page 4

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