Form Nc-5px - Amended Withholding Payment Voucher

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Amended Withholding Payment Voucher
North Carolina Department of Revenue
Enter Date Compensation Paid
(MM-DD-YY)
,
,
.
1.
Additional Tax
00
,
,
.
2. Penalty
00
,
,
.
3.
Interest
00
Signature:
Date:
I certify that, to the best of my knowledge, this return is accurate and complete.
$
,
,
.
4.
Total Due
00
(
)
Phone:
Title:
MAIL TO: P.O. Box 25000, Raleigh, NC 27640-0050
NC-5PX
7-01

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