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D-400 (SD)
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12 45 14
For calendar year 2014, or fiscal year beginning
12 45 78
and ending
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ABCDEFGHIJKLMNO A ABCDEFGHIJKLMNOPQRSTU
5121 VALDEZ COURT 11056
RALEIGH NC 27605-0001 WAKE FRNCOUNTRY
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Filing Status
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X
1. Single
2. Married Filing Jointly
Your SSN:
Spouse’s SSN:
3. Married Filing Separately
Yes
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X
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123456789
123456789
Select box if you or your spouse were
out of the country on April 15 and a
U.S. citizen or resident.
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Select box if return is filed and signed
by Executor or Administrator.
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4. Head of Household
No
Were you a resident of N.C. for the entire year of 2014?
Was your spouse a resident for the entire year?
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5. Widow(er) with Dependent Child
Return for deceased taxpayer
Return for deceased spouse
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1234
12 45 78
12 45 78
Year spouse died:
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Date of death:
Date of death:
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N.C. Education Endowment Fund: You may contribute to the N.C. Education Endowment Fund by making a contribution or designating some or all of
your overpayment to the Fund. To make a contribution, enclose Form NC-EDU and your payment of $ 12345678. To designate your overpayment
to the Fund, enter the amount of your designation on Page 2, Line 28. See instructions for information about the Fund.
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FS
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2
PP
Y
DT
Y
OC
N
TD
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ABCD
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ABCD
12345
DS
N
EA
N
SD
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ALEXANDERX15MAX
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K
MCALLISTERXXXXX20MAX
123456789
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MICHELLEXX15MAX
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Q
MCALLISTERXXXXX20MAX
123456789
NC
27605
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11056
5121 VALDEZ CTXXXXXXXXXXXXXXXX35MAX
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RALEIGHXXXXXXXX20MAX
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06-12345678
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12345678
23B12345678
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0712345678
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N
0912345678
20A12345678
23C12345678
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23E12345678
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1112345678
20B12345678
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Y
21A12345678
13456
21B12345678
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21C12345678
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12345678
21D12345678
1612345678
23A12345678
EUF
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3012345678
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TN1234567890
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PN1234567890
PPA12345678
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Sign Return Below
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12345678
Refund Due
12346578
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If prepared by a person other than taxpayer, this certification is based on all information of
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which the preparer has any knowledge.
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Payment Due
I certify that, to the best of my knowledge, this return is accurate and complete.
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Your Signature
Date
Spouse’s Signature (If filing joint return, both must sign.)
Date
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Paid Preparer’s Signature
Date
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Home Telephone Number (Include area code)
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Paid Preparer’s FEIN, SSN, or PTIN
Paid Preparer’s Telephone Number
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If you ARE NOT due a refund, mail return, any payment, and Form D-400V to: NCDOR, P.O. Box 25000, Raleigh, N.C. 27640-0640
If REFUND mail to: NCDOR, P.O. Box R, Raleigh, N.C. 27634-0001
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North Carolina Department of Revenue
Return and W-2s Here
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30
Individual Income Tax Return 2014
11-24-14
< Staple All Pages of Your
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D-400 2014 Page 2
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(SD)
MCALLISTER
Last Name (First 10 Characters)
123456789
Your Social Security Number
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D-400 Line-by-Line Information
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6.
Federal adjusted gross income
6.
11
7.
8.
9.
Additions to federal adjusted gross income
Add Lines 6 and 7
Deductions from federal adjusted gross income
7.
8.
10.
11.
Subtract Line 9 from Line 8
N.C. standard deduction OR itemized deduction
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10.
11.
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12.
Did you claim the standard deduction on federal form 1040
Subtract Line 11 from Line 10
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13.
14.
Part-year residents and nonresidents
N.C. Taxable Income
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15.
16.
17.
18.
N.C. Income Tax
Tax Credits
Subtract Line 16 from Line 15
Consumer Use Tax
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16.
17.
18.
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13.
You certify that no Consumer Use Tax is due
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19.
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19.
Add Lines 17 and 18
-12345678
12345678
-12345678
12345678
-12345678
12345678
Y
-12345678
1.3456
-12345678
12345678
12345678
12345678
12345678
Y
12345678
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North Carolina Income Tax Withheld
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20a.
Your Income Tax Withheld
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20b.
Spouse’s Income Tax Withheld
20b.
12345678
12345678
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Other Tax Payments
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21a.
21b.
21c.
2014 Estimated Tax
Paid with Extension
Partnership
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21b.
21c.
21d.
22.
S Corporation
Add Lines 20a through 21d
21d.
22.
23a.
23b.
Tax Due - If Line 19 is more than Line 22, subtract and enter the result
Penalties
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23b.
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23c.
Interest
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23d.
Add Lines 23b and 23c and enter the total
23d.
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EU
23e.
24.
Exception to underpayment of estimated tax
Interest on the underpayment of estimated income tax
Pay this Amount
EU
23e.
24.
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12345678
12345678
12345678
12345678
12345678
12345678
12345678
12345678
12345678
F
12345678
12345678
12345678
25.
Overpayment - If Line 19 is less than Line 22, subtract and enter the result
25.
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Amount of Refund to Apply to:
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26.
27.
Amount of Line 25 to be applied to 2015 Estimated Income Tax
N.C. Nongame and Endangered Wildlife Fund
28.
29.
N.C. Education Endowment Fund
Add Lines 26, 27, and 28
30.
Amount to be Refunded
12345678
12345678
12345678
12345678
12345678
26.
27.
28.
29.
30.
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This page must be filed with the first page of this form.
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