Form Nd-Ez - Individual Income Tax Return - 2013
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1Form
North Dakota Office of State Tax Commissioner
E Z
Individual income tax return
ND-
2013
for full-year residents with no adjustments or credits
WEB
Deceased
Date of death
Your social security number*
Your name (First, MI, Last name)
Deceased
Date of death
If joint return, spouse's name (First, MI, Last name)
Spouse's social security number*
Apt No.
Mailing address
Fill in if you obtained an
extension of time to file
State
City
Zip code
your return: (See page 9)
Extension
A. Filing status used on federal return: (Fill in only one)
C. Income source code:
B. School district code:
(See page 9)
1. Single
4. Head of household
(See page 19)
2. Married filing jointly
5. Qualifying widow(er)
with dependent child
3. Married filing separately
Federal adjusted gross income
For a complete return, you must complete Line D. If zero, enter 0.
Tax calculation
D. Federal adjusted gross income from line 37 of Form 1040,
line 21 of Form 1040A, or line 4 of Form 1040EZ
(SX) D
Tax calculation
1. Federal taxable income from line 43 of Form 1040, line 27 of Form 1040A,
or line 6 of Form 1040EZ. This is your North Dakota taxable income
(ND) 1
2. Tax - Enter tax on amount on line 1 from Tax Table on page 20 of instructions
(SB) 2
Tax paid
3. North Dakota withholding (Attach W-2s, 1099s, and/or North Dakota K-1s)
(SF) 3
Refund
4. Overpayment - If line 3 is MORE than line 2, subtract line 2 from line 3;
otherwise, go to line 7. If less than $5.00, enter 0
(SG) 4
Trees For ND
5. Voluntary
Watchable
Enter
Program Trust Fund
contribution to:
5
Wildlife Fund
total
(SP)
(SW)
6. Refund. Subtract line 5 from line 4. If less than $5.00, enter 0
(SR) 6
To direct deposit
Type of account
a.
Routing number:
c.
refund, complete items
Checking
a, b, and c. (See page 9)
b. Account number:
Savings
Tax due
7. Tax due - If line 3 is LESS than line 2, subtract line 3 from line 2.
If less than $5.00, enter 0
(SZ) 7
8. Voluntary
Watchable
Trees For ND
Enter
contribution to:
Wildlife Fund
Program Trust Fund
8
(SU)
(SY)
total
9. Balance due. Add lines 7 and 8. Pay to: ND State Tax Commissioner
9
For a complete return, you must attach a copy of your 2013 federal tax return
I declare that this return is correct and complete to the best of my knowledge and belief.
* Privacy Act - See inside front cover of booklet.
Your signature
Date
Phone number (land line)
I authorize the ND Office of State Tax Commissioner to
discuss this return with the paid preparer.
Spouse's signature
Cell phone no.
This Space Is For Tax Department Use Only
Date
Paid preparer signature
PTIN
Date
IIT
Phone no.
Print name of paid preparer
i
t
Mail to: Office of State Tax Commissioner,
PO Box 5621, Bismarck, ND 58506-5621
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