North Carolina Department Of Revenue (Form Nc 8633) Application To Participate In The Electronic Filing Program
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1
2FORM NC 8633
NORTH CAROLINA DEPARTMENT OF REVENUE
(Rev. 9--98)
APPLICATION TO PARTICIPATE IN THE ELECTRONIC FILING PROGRAM
(Web)
(IMPORTANT: This application must be received by the N. C. Department of Revenue
on or before December 1 preceding the tax year for which this application is made.)
This application is (check one)
new.
revised.
If revised please check the change you are making:
Business name
Contact person name or phone
Business address
Other (specify)
Electronic Filing Functions Performed
Drop off, collection points and/or branches
PART I
.
Write your current Electronic Filer Identification Number (EFIN) and if applicable, your Electronic Transmitter Identification Number (ETIN)
EFIN:
ETIN:
Business Name
Federal Employer Identification Number (FEIN)
County
Mailing Address: (Street, P. O. Box, City, State, Zip Code)
Business Address: (Street, P. O. Box, City, State, Zip Code)
Contact Representative Name
Alternate Contact Representative Name
Social Security Number
Social Security Number
Daytime Phone Number
Fax Phone Number
Daytime Phone Number
(
)
(
)
(
)
Check the box that indicates your firm’s organizational structure and indicate when your firm was formed.
Sole Proprietorship
Partnership
Corporation
Other (specify)
/
/
Date Firm Formed
PART I I
Please answer the following questions by checking the appropriate box:
YES
NO
a.
Will you transmit tax return data directly to the IRS? If yes, name of software
a.
If no, name of transmitter
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b.
Will you develop electronic filing software? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b.
c.
Will you prepare tax returns, including Form NC 8453, or collect completed returns, including Forms NC 8453,
c.
for the purpose of filing electronically? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d.
Will you have branch offices that will collect, prepare or transmit electronic returns. If yes, complete page 2. . .
d.
e.
Will you have drop- -off collection points where taxpayers can drop off their completed returns, including
e.
Form NC 8453? If yes, complete page 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
f.
f.
Has the firm or any corporate officer, partner, owner or responsible official:
1.
been convicted of a monetary crime? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.
failed to file personal or business tax returns, or unpaid tax liabilities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.
been convicted of any criminal offense under the revenue laws of the State of North Carolina? . . . . . . . . . .
g.
Is the firm open 12 months a year? If no, telephone number where you may be reached.
g.
APPLICANT AGREEMENT
Under the penalties of perjury, I affirm that I have examined this application and any accompanying information, and to the best of my knowledge and belief it is true,
correct and complete. This firm and its employees will comply with all the provisions of the Internal Revenue Service Publication 1345 Handbook for Electronic Filers
of Individual Income Tax Returns and North Carolina Department of Revenue Handbook for Electronic Filers of Individual Income Tax Returns, and related publications
for years of participation. I understand that if this firm is sold or its organizational structure is changed, acceptance for participation is not transferable; a new application
must be filed. I further understand that noncompliance will result in the firm no longer being allowed to participate in the program. I am aware that I must be accepted
by the Internal Revenue Service to enable my participation in Federal/State Electronic Filing. I am authorized to make and sign this statement on behalf of the firm.
Name and Title of firm official and/or principal owner (Type or Print)
Social Security Number
Signature of firm official and/or principal owner
Date
N. C. DEPARTMENT OF REVENUE
For additional Information and Assistance Call:
Mail Complete Form To:
N. C. Department of Revenue
ELECTRONIC FILING
Electronic Filing Help Desk
P. O. BOX 2628
(919) 733- -1674
RALEIGH, N. C. 27602
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