Form D-400v - Payment Voucher - North Carolina Department Of Revenue

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Do not use this payment voucher if you pay your tax online.
North Carolina
Form D-400V
Department of Revenue
Payment Voucher
Your Social Security Number
Spouse’s Social Security Number
You must enter your
social security number(s)
Enter the amount of your payment.
This must match the amount shown on your check or
money order. Use blue or black ink on this voucher and
your check. Do not use red ink.
$
.
,
,
00
Mail to: N.C. Department of Revenue, P.O. Box 25000, Raleigh, N.C. 27640-0640
D-400V
9-04
7280101005

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