Form D-400x-Ws - Worksheet For Amending A 2011 Individual Income Tax Return Page 3
Download a blank fillable Form D-400x-Ws - Worksheet For Amending A 2011 Individual Income Tax Return in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form D-400x-Ws - Worksheet For Amending A 2011 Individual Income Tax Return with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4
5
6
7
84
Individual Income
D-400
Web-Fill
Tax Return 2011
10-11
PRINT
CLEAR
North Carolina Department of Revenue
IMPORTANT: Do not send a photocopy of this form.
For calendar year 2011, or fiscal year beginning
and ending
(MM-DD-YY)
(MM-DD-YY)
Your Social Security Number
Spouse’s Social Security Number
You must enter your
social security number(s)
Your First Name
M.I.
Your Last Name
(USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS)
If a Joint Return, Spouse’s First Name
M.I.
Spouse’s Last Name
Mailing Address
Apartment Number
City
State
Zip Code
County
Country (If not U.S.)
(Enter first five letters)
Fill in circle if you or your spouse were out of the country on April 15 and a U.S. citizen or resident.
Fill in circle if this is an AMENDED 2011 return.
IMPORTANT: You must also complete Form D-400X-WS, Worksheet for Amending
2011 Individual Income Tax Return, and attach it to the front of your amended return.
(Note: This form cannot be used for tax years other than 2011.)
Deceased Taxpayer Information
N.C. Public Campaign Fund
N.C. Political Parties Financing Fund
Mark ‘Yes’ if you want to designate $3 of
Fill in appropriate circle if you want to designate
Fill in circle if return is filed and signed by Executor,
taxes to this special Fund for voter education
$3 to this fund. Your tax remains the same
Administrator or Court-Appointed Personal Representative.
materials and for candidates who accept
whether or not you make a designation.
Taxpayer
spending limits. Marking ‘Yes’ does not
(MM-DD-YY)
You
Your Spouse
change your tax or refund.
If return is for a
Democratic
Democratic
deceased taxpayer
You
Your Spouse
Republican
Republican
Spouse
or deceased spouse,
(MM-DD-YY)
Fill in
Yes
Libertarian
Libertarian
Yes
enter date of death.
appropriate
circle
No
Unspecified
Unspecified
No
Federal Adjusted Gross Income
Enter federal adjusted gross income from your federal return
(Form 1040, Line 37; Form 1040A, Line 21; or Form 1040EZ, Line 4)
If No, complete Lines 1 through 11. Then go
Were you a resident of N.C. for the entire year of 2011?
Yes
No
Residency
to Page 4 of Form D-400. Fill in residency
Status
Was your spouse a resident for the entire year?
Yes
No
information and complete Lines 54 through 56.
Filing Status
Same as federal. Fill in one circle only. If your spouse was a nonresident and had no North
Carolina taxable income in 2011, see the Line Instructions for Lines 1 through 5. If you do not
Enter the Number of
1.
indicate your filing status by filling in one of the circles, any refund due will be delayed.
Single
Exemptions claimed
on your federal
2.
Married Filing Jointly
income tax return
Name
(Enter your spouse’s
3.
Married Filing Separately
full name and Social
Security Number)
4.
Head of Household
SSN
5.
Qualifying Widow(er) with Dependent Child
)
(Year spouse died:
Enter Whole U.S. Dollars Only
6. Taxable Income from Your Federal Income Tax Return
Form 1040, Line 43; Form 1040A, Line 27; or Form 1040EZ, Line 6
6.
(If zero, see the Line Instructions)
7.
Additions to Federal Taxable Income
All taxpayers must complete Lines 31 through
7.
41 on Page 3 and enter amount from Line 41
8. Add Lines 6 and 7
8.
9.
Deductions from Federal Taxable Income
9.
If applicable, complete Lines 42 through 53 on
Pages 3 and 4 and enter amount from Line 53
10. Line 8 minus Line 9
10.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial