Form D-400x - Amended North Carolina Individual Income Tax Return - 2012 Page 4
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Last Name (First 10 Characters)
Your Social Security Number
Tax Year
D-400X Web-Fill
2012
12-12
Computation of North Carolina Taxable Income for Part-Year Residents and Nonresidents
(See Line Instructions beginning on Page 15. Note: Do not complete Lines 50 through 52 if you were a full-year resident.)
Fill in applicable circles
You
Spouse
Fill in circle(s) if you or your spouse moved into or out of North Carolina during the year and enter the dates of residency in the boxes.
You
Spouse
Date residency began
Date residency began
Date residency ended
Date residency ended
(MM-DD-YY)
(MM-DD-YY)
(MM-DD-YY)
(MM-DD-YY)
Fill in circle(s) if you or your spouse were nonresidents of North Carolina for the entire year.
Part-year residents and nonresidents must read the instructions on Page 15 and complete the worksheet on Page 16 to determine the amounts to
enter on Lines 50 and 51 below.
50. Enter the amount from Column B, Line 33 of the Part-Year
50.
Resident/Nonresident Worksheet on Page 16 of the Instructions.
Enter the amount from Column A, Line 33 of the Part-Year
51.
51.
Resident/Nonresident Worksheet on Page 16 of the Instructions.
52. Divide Line 50 by Line 51
(Enter the result as a decimal amount here and on Line 16; round
52.
to four decimal places.)
Explanation of Changes
Give the reason for each change. Attach all supporting forms and schedules for the items changed. Be sure to include your name and
social security number on any attachments. If the changes are also applicable to your federal return, include a copy of Federal Form
1040X. If there was a change to wages or State withholding, be sure to include corrected Forms W-2 or 1099. Refunds will not be
processed without a complete explanation of changes and required attachments.
I certify that, to the best of my knowledge, this return is
If prepared by a person other than taxpayer, this certification is
based on all information of which the preparer has any knowledge.
accurate and complete.
Your Signature
Paid Preparer’s Signature
Date
Date
Spouse’s Signature (If filing joint return, both must sign.)
Preparer’s FEIN, SSN, or PTIN
Date
Daytime Telephone Number (Include area code.)
Preparer’s Telephone Number (Include area code.)
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