Form Nc-3m - Annual Withholding Reconciliation Return - North Carolina Department Of Revenue

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NC-3M
Annual Withholding Reconciliation Return
12-99
North Carolina Department of Revenue
Business Name & Address
Account ID
Tax Year
Due: February 28
Enter Total Adjusted Tax for Each Month Below.
Month
Amount
1. January
1.
2. February
2.
3. March
3.
4. April
4.
5. May
5.
6. June
6.
7. July
7.
8. August
8.
9. September
9.
10. October
10.
11. November
11.
12. December
12.
13. Total Tax Withheld (Add Lines 1 - 12)
13.
Note: If the amount on
14a. Tax Withheld Per W-2 Statements
14a.
Line 13 differs from
the amount on Line
15, see instructions for
15a. Tax Withheld Per 1099 Statements
14b.
Line 15.
16. Total Tax Withheld Per Statements
15.
Signature:
Date:
I certify that, to the best of my knowledge, this return is accurate and complete.
(
)
Title:
Phone:
MAIL TO: North Carolina Department of Revenue, Post Office Box 25000, Raleigh, North Carolina 27640-0001

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