Form D-400ez -1999 - Individual Income Tax Return
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1Individual Income
D-400EZ
Tax Return 1999
North Carolina Department of Revenue
Print in Black or Blue Ink Only.
See reverse to determine if you can use this form.
Your Social Security Number
Spouse’s Social Security Number
You must enter your
è
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
County
(Enter first five letters)
Address
City
State
Zip Code
Incorrect responses may delay any refund due.
1.
3.
4.
Single
Married Filing Separately
Enter the Number
(Enter your spouse’s full name and SSN)
Filing
of Exemptions
Status
claimed on your
Name
federal income tax
Same as federal.
return
2.
Married Filing
Fill in one circle only.
SSN
Jointly
,
.
If amount
00
on Line 5 or
(If zero, see Line Instructions on reverse)
,
Line 7 is
.
negative,
00
(Complete the Standard Deduction/Personal Exemption Adjustment
fill in circle.
Worksheet on reverse side of this form and enter result here)
,
.
Example:
00
,
.
(If Line 7 is less than $68,000, use the Tax Table beginning on Page 15 to
00
determine the tax. Otherwise, use the Tax Rate Schedule on Page 23)
,
.
00
See instructions)
,
.
00
,
.
a. Your tax withheld
00
(Staple the original or copy of the original State
wage and tax statement(s) in the top left-hand
,
.
corner of the return)
b. Spouse’s tax withheld
00
,
.
00
,
.
$
00
,
.
00
,
.
00
,
.
00
,
.
00
,
.
00
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