Form D-400 - Individual Income Tax Return - 2009
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4Individual Income
D-400
Web
Tax Return 2009
9-09
North Carolina Department of Revenue
Print in Black or Blue
Ink Only. No Pencil
IMPORTANT: Do not send a photocopy of this form.
or Red Ink.
0 9
For calendar year 2009, or fiscal year beginning
and ending
(MM-DD)
(MM-DD-YY)
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
Address
Apartment Number
City
State
Zip Code
Country (If not U.S.)
County
(Enter first five letters)
Fill in circle if you or your spouse were out of the country on April 15 and a U.S. citizen or resident.
Fill in circle if this is an AMENDED 2009 return.
Important: You must also complete Form D-400X-WS, Worksheet for Amending 2009
Individual Income Tax Return, and attach it to the front of your amended return.
(Note: This form cannot be used for tax years prior to 2009.)
Deceased Taxpayer Information
N.C. Public Campaign Fund
N.C. Political Parties Financing Fund
Mark ‘Yes’ if you want to designate $3 of
Fill in appropriate circle if you want to designate
Taxpayer
(MM-DD-YY)
taxes to this special Fund for voter education
$3 to this fund. Your tax remains the same
If return is for a
materials and for candidates who accept
whether or not you make a designation.
deceased taxpayer
spending limits. Marking ‘Yes’ does not
Spouse
or deceased spouse,
(MM-DD-YY)
You
Your Spouse
change your tax or refund.
enter date of death.
Democratic
Democratic
You
Your Spouse
Fill in
Fill in circle if return is filed and signed by Executor
Republican
Republican
Yes
Yes
appropriate
or Administrator.
circle
No
Unspecified
Unspecified
No
Federal Adjusted Gross Income
,
,
.
Fill in circle
Enter federal adjusted gross income from your federal return
00
if negative
(Form 1040, Line 37; Form 1040A, Line 21; or Form 1040EZ, Line 4)
Were you a resident of N.C. for the entire year of 2009?
If No, complete Lines 1 through 11. Then go
Yes
No
Residency
to Page 4 of Form D-400. Fill in residency
Status
Was your spouse a resident for the entire year?
Yes
No
information and complete Lines 54 through 56.
Filing Status
Same as federal. Fill in one circle only. If your spouse was a nonresident and had no North
Carolina taxable income in 2009, see the Line Instructions for Lines 1 through 5. If you do not
Enter the Number of
indicate your filing status by filling in one of the circles, any refund due will be delayed.
1.
Single
Exemptions claimed
on your federal
2.
Married Filing Jointly
income tax return
Name
(Enter your spouse’s
3.
Married Filing Separately
full name and Social
4.
Security Number)
Head of Household
SSN
5.
Qualifying Widow(er) with Dependent Child
)
(Year spouse died:
Enter Whole U.S. Dollars Only
6. Taxable Income from Your Federal Income Tax Return
,
,
.
Form 1040, Line 43; Form 1040A, Line 27; or Form 1040EZ, Line 6
6.
00
(If zero, see the Line Instructions)
If amount on
,
,
.
7. Additions to Federal Taxable Income
Line 6, 8, 10,
All taxpayers must complete Lines 32 through 42
7.
00
11, or 13 is
on Page 3 and enter amount from Line 42
negative,
fill in circle.
,
,
.
8. Add Lines 6 and 7
8.
00
Example:
,
,
.
9. Deductions from Federal Taxable Income
9.
If applicable, complete Lines 43 through 53 on Page 3
00
and enter amount from Line 53
,
,
.
10. Line 8 minus Line 9
10.
00
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