Form D-400 - Schedule Am - North Carolina Amended Schedule - 2016

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D-400 Schedule AM
2016 North Carolina Amended Schedule
Important: You must complete Form D-400 and fill in the applicable circle indicating amended return.
Attach this schedule to the front of your North Carolina amended D-400 return. (See Instructions.)
Your Social Security Number
Spouse’s Social Security Number
You must enter your
social security number(s).
Your First Name
(USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS)
M.I.
Your Last Name
If a Joint Return, Spouse’s First Name
M.I.
Spouse’s Last Name
Mailing Address - If this is a change, fill in applicable circle.
Apartment Number
City
State
Zip Code
Country (If not U.S.)
County
(Enter first five letters)
Reason(s) for Amending Your Return
Fill in the circles for all applicable boxes.
Federal audit change
(Attach federal audit report.)
Additional Income
(Include W-2, 1099, or K-1.)
Adjustments to D-400 Schedule S
(Attach Schedule S and any supporting explanations or schedules.)
Tax Credits
(Attach Form D-400TC.)
Filing Status (Note: You cannot change from joint to separate returns after the due date of the original return.)
Change in Social Security Number or ITIN (SSN or ITIN on original return _____-_____-_______ )
Original return has previously been audited by the Department.
Net operating loss
(Include copy of your federal form 1045, including Schedules A and B.)
Injured/innocent spouse
Tax Treaties
Other
Explanation of Changes
Give the reason for each change. Attach all supporting forms and schedules for the items changed. Be sure to include your name and social
security number on any attachments. If the changes are also applicable to your federal return, include a copy of Federal Form 1040X. If
there was a change to wages or State withholding, be sure to include corrected Forms W-2 or 1099. Refunds will not be processed without
a complete explanation of changes and required attachments.
Mail Form D-400 Schedule AM, Form D-400, all required schedules, supporting forms, and, if applicable, payment for the amount shown due on
Form D-400, Line 27 and Form D-400V Amended to:
N.C. DEPARTMENT OF REVENUE, P.O. BOX 25000, RALEIGH, NC 27640-0640

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