Form Nc-14 - Notice Of Contingent Event Or Request To Extend Statute Of Limitations - North Carolina Department Of Revenue
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1NC-14
Notice of Contingent Event or Request to Extend Statute of Limitations
Web
North Carolina Department of Revenue
4-14
Part 1. Taxpayer’s Information
Tax Type (Fill in applicable circle):
Individual
Corporate
Sales and Use
Excise
Other (Specify) ___________________________________
Individual’s First Name
M.I.
Individual’s Last Name
Individual’s Social Security Number
Spouse’s First Name (If joint return filed)
M.I.
Spouse’s Last Name (If joint return filed)
Spouse’s Social Security Number
Entity’s Legal Name (First 32 Characters)
Federal Employer ID Number
Entity’s Trade Name
Account ID/NCDORID
Address
Period Beginning (MM-DD-YY)
City
State
Zip Code
Period Ending (MM-DD-YY)
Contact Person if Questions
Phone Number of Contact Person
(
)
Part 2. Contingent Event
(See instructions for definition of contingent event)
Use the space below to describe in clear terms the contingent event and the basis used to determine the estimated
amount of overpayment
(Attach documentation)
Provide the following information:
,
,
.
$
Return or Payment Affected
Estimated amount of overpayment
Part 3. Event or Condition other than a Contingent Event
(See instructions for definition of event or condition other than a
)
contingent event
Use the space below to provide clear and convincing proof that the event or condition described prevents the timely
filing of an accurate and definite request for refund
(Attach documentation)
Provide the following information:
,
,
.
$
Return or Payment Affected
Estimated amount of overpayment
Taxpayer Signature:
Title:
Date:
Signature of
Taxpayer’s Representative:
Date:
If a taxpayer’s representative signs this form, a Power of Attorney must accompany this request.
MAIL TO: North Carolina Department of Revenue, P.O. Box 871, Raleigh, North Carolina 27602-0871.
Address the envelope to the attention of the taxing division for the tax to which the event or condition applies.
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