Form D-400-TC Fillable Individual Income Tax Return and Form D-400TC, Individual Tax Credits
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

$50 000) complete Lines 16 through 18 Otherwise do not complete Lines 16 through 18; you may not claim the credit for children D 400 and your name address and social security number on the payment If filing a joint return write both (Add Lines 46a 46b 46c 46d and 46e and enter on Line 46f ) 46f (Add Lines 47a 47b and 47c and enter on Line 47d ) 47d (Bailey settlement Important: See Line instructions on Page 14) (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (CLEAR) CLEAR (combobox) (combobox) (Enter your total charitable contributions on Line 20a (FEIN SSN or PTIN) (From Form D 400TC Part 5) (MM DD YY) (MM DD YY) (PRINT) PRINT (See Credit for Child and Dependent Care Expenses on Page 17 for additional information ) (See instructions on Page 13) (See instructions on Page 15) (See instructions on Page 17 Net tax paid is the total taxes paid [withholding estimated tax payments (See Line instructions and enter letter in box if applicable) (See Line Instructions beginning on Page 15 Note: Do not complete Lines 53 through 55 if you were a full year resident ) (See Line instructions on Page 15 for deduction limitations) (See Line instructions on Page 15 for explanation of qualifying severance wages) 45 (Staple original or copy of the original State (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (You must fill in appropriate circle See instructions on Pages 7 8 and 9) 1 0000 enter the amount from Line 16 here and on Line 18 below 1 Total income from all sources (combined for joint filers) from Federal Form 1040 Line 22; 1040A 10 Credit (Use the Child and Dependent Care Credit Table on Page 17 Multiply the amount on 10 Subtract Line 9 from Line 8 10 11 N C standard deduction OR N C itemized deductions 11 Other qualifying expenses (Line 8 minus Line 9) 12 Credit (Use the Child and Dependent Care Credit Table on Page 17 of the instructions 13 Total credit for child and dependent care expenses (Line 10 plus Line 12) 14 Part year residents and nonresidents multiply the amount on Line 13 of this form by the 15 Enter amount from Line 14 15 15 Total credit for child and dependent care expenses from Line 13 or Line 14 (Include the 16 Multiply the number of children for whom you are entitled to claim the federal child tax credit by $100 and 16 of Form D 400 is more than 1 0000 enter the amount from Line 13 here and on Line 15 below 16 Part year residents and nonresidents 17 North Carolina Taxable Income 17 Part year residents and nonresidents multiply the amount on Line 16 by the decimal amount from Form 18 Credit for children (Include the amount on this line in the total on Line 19 Part 4 ) 18 18 North Carolina Income Tax If the amount on Line 17 is less than $68 000 use the Tax Table 19 Tax Credits (From Form D 400TC Part 4 Line 37 You must attach Form D 400TC 19 Total of Parts 1 2 and 3 (Add Lines 7a 15 and 18 ) 19 2 The portion of Line 1 that was taxed by another state or country 20 Credit for charitable contributions by nonitemizers 20 Subtract Line 19 from Line 18 20 2013 Individual Tax Credits 21 Consumer Use Tax (See instructions on Page 10) 21 Credit for long term care insurance premiums (Complete the Worksheet for Determining TaxCredit for Premiums Paid on Long term Care Insurance Contracts on Page 19 of the instructions ) 22 Add Lines 20 and 21 22 22 Credit for adoption expenses (Complete the Adoption Tax Credit Worksheet on Page 19 of the instructions ) 23 Credit for children with disabilities who require 23 North Carolina Income Tax Withheld 24 Credit for Qualified Business Investments (See instructions on Page 19 You must attach a copy of 24 Other Tax Payments 25 Credit for disabled taxpayer dependent or spouse (Complete Form D 429 Worksheet for 25 North Carolina Earned Income Tax Credit 26 Add Lines 23a through 25 and enter the total on Line 26 26 26 Credit for certain real property land donations (See instructions on Page 20 ) 27 a Tax Due If Line 22 is more than Line 26 subtract and enter the result 28 Add Lines 27a 27b 27c and 27d and enter the total Pay This Amount 29 Overpayment If Line 22 is less than Line 26 subtract and enter the result 29 3 Divide Line 2 by Line 1 and enter the result as a decimal amount (Round to four decimal places ) 3 30 Amount of Line 29 to be applied to 2014 Estimated Income Tax 31 Contribution to the N C Nongame and Endangered Wildlife Fund 31 Other miscellaneous income tax credits (See instructions on Page 20 ) 32 Add Lines 30 and 31 32 32 Tax credits carried over from previous year if any Do not include any 33 Subtract Line 32 from Line 29 and enter the Amount To Be Refunded 33 Total (Add Lines 19 20b 21 22 23 24 25 26 27b 28b 29b 30b 31 and 32) 34 Amount of total North Carolina income tax (From Form D 400 Line 18) 34 Interest income from obligations of states other than North Carolina 34 35 Adjustment for bonus depreciation (See instructions on Page 13) 35 35 Enter the lesser of Line 33 or Line 34 36 Adjustment for section 179 expense deduction (See instructions on Page 13) 36 36 Business incentive and energy tax credits (Seeinstructions on Page 21 Attach Form NC 478 37 Adjustment for tuition and fees deduction Form 1040 Line 34 or Form 1040A Line 19 38 Enter the amount of your federal earned income tax credit Number of qualifying children 38 Other additions to federal adjusted gross income (Attach explanation or schedule) 38 39 Total additions Add Lines 34 through 38 (Enter the total here and on Line 7) 39 4 Total North Carolina income tax (From Form D 400 Line 18) 40 State or local income tax refund if included on Line 10 of Federal Form 1040 40 41 Interest income from obligations of the United States or United States possessions 41 42 Taxable portion of Social Security and Railroad Retirement Benefits 43 Retirement benefits received from vested N C State government 44 If you have retirement benefits not reported on Lines 42 or 43 complete the 45 Severance wages 46b 200946a 2008 46c 2010 46e 201246d 2011 47 Adjustment for section 179 expense deduction added back in 2010 2011 and 2012 (See Line instructions on Page 15) 47a 2010 47b 2011 47c 2012 48 Contributions to North Carolina s National College Savings Program (NC 529 Plan) 49 Adjustment for absorbed NOL added back in 2003 2004 2005 and 2006 5 Computed credit (Multiply Line 3 by Line 4) 5 51 Other deductions from federal adjusted gross income (Attach explanation or schedule 52 Total deductions Add Lines 40 through 51 (Enter the total here and on Line 9) 52 53 Enter the amount from Column B Line 34 of the Part Year 54 Enter the amount from Column A Line 34 of the Part Year 55 Divide Line 53 by Line 54 (Enter the result as a decimal amount here and on Line 16; round 6 Amount of net tax paid to the other state or country on the income shown on Line 2 6 Federal adjusted gross income(Form 1040 Line 37; Form 1040A Line 21; or Form1040EZ Line 4) (If negative see the Line instructions) 7 7 Additions to federal adjusted gross income(If applicable complete Lines 34 through 39 on Page 3and enter amount from Line 39) 7a Enter the lesser of Line 5 or Line 6 and include in the total on Line 19 Part 4 7b Enter in the box the number of states for which credits are claimed 8 Add Lines 6 and 7 8 8 Enter the expenses from Line 3 of Federal Form 2441 9 9 Deductions from federal adjusted gross income(If applicable complete Lines 40 through 52 on Page 3and enter amount from Line 52) 9 Enter the portion of Line 8 that was incurred for dependent(s) who were under the age of a 2013 Estimated Tax a Your tax withheld accurate and complete based on all information of which the preparer has any knowledge Add Lines 35 and 36 (Enter the total here and on Form D 400 Line 19 ) Additions to Federal Adjusted Gross Income (See Line Instructions beginning on Page 12 ) Adjustment for bonus depreciation added back in 2008 2009 2010 2011 Adjustment for net business income that is not considered passive income (See instructions on Page 15)50 50 All Pages of Amended Returns amount of credit amount of credit amount on this line in the total on Line 19 Part 4 ) amount paid with extension other payments] less any refunds received or expected to be received ) and 2012 (See Line instructions on Page 15) and 51of Form D 400 Do not make an adjustment for domestic production activities included on Line 38 and any required supporting schedules to thefront of your income tax return ) and ending (MM DD YY) and enter the result here ) and proof of payment Important: If you claim a tax credit for tax paid to more than one state or country do not fill in Lines 1 through 6; instead see instructions on Page 16 are payable in U S dollars Please do not staple tape paper clip or otherwise attach your payment or voucher attach a copy of the NC K 1 b Paid with Extension b Penalties b Spouse s tax withheld Be sure to sign and date your return on Page 4 beginning on Page 22 of the instructions to determine your tax If the amount on Line 17 is $68 000 c Interest c Partnership carryover of tax credits claimed on Form NC 478 Complete Lines 53 through 55 on Page 4 and enter Computation of North Carolina Taxable Income for Part Year Residents and Nonresidents Conservation Tillage Equipment Recycling Oyster Shells corner of the return) Credit for rehabilitating a nonincome producing historic mill facility (See instructions on Page 20 ) Credit for rehabilitating a nonincome producing historic structure (See instructions on Page 20 ) Credit for rehabilitating an income producing historic mill facility (See instructions on Page 20 ) Credit for rehabilitating an income producing historic structure (See instructions on Page 20 ) D 400 D 400 Line 16 and enter the result here and on Line 18 below If Line 16 of Form D 400 is more than 17 D 400 Line 16 and enter the result here and on Line 25 of Form D 400 If Line 16 of Form D 400 is more D 400 Web Fill D 400 Web Fill D 400TC D 400TC Web Fill D 400V Enclose the voucher with your return and payment and mail to the address listed above If you do not pay d Interest on the underpayment of estimated income tax d S Corporation Date residency began Date residency ended Deceased Taxpayer Information decimal amount from Form D 400 Line 16 and enter the result here and on Line 15 below If Line decimal amount from Line 55 Deductions from Federal Adjusted Gross Income(See Line Instructions beginning on Page 13 ) dependent children Determining the Credit for the Disabled Taxpayer Dependent or Spouse and Do not enter more than $350 per contract Do not include any deduction for retirement benefits on this line ) Enter expenditures and expenses on Lines 27a 28a 29a and 30a only in the first year the credit is taken enter on Lines 53 and 54 below Enter qualifiedrehabilitation expenditures 27a Enter installment Enter qualifiedrehabilitation expenditures 29a Enter amount of credit Enter rehabilitation enter the amount from Line 13 or 14 whichever is applicable ) Enter the Number enter the result here (Full year residents enter this amount here and on Line 18 below ) Enter Whole U S Dollars Only Enter Whole U S Dollars Only Example: Exception tounderpaymentof estimated tax expenses 28a Enter installment expenses 30a Enter installment Filing Status Fill in one circle only (See instructions on Page 7) Fill in applicable circles Fill in applicable circles: Fill in circle if Fill in circle if return is filed and signed by Executor Administrator or Court Appointed Personal Representative 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(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 Fill in circle(s) if you or your spouse were nonresidents of North Carolina for the entire year Fill in residency information and complete Lines 53 through 55 For calendar year 2013 or fiscal year beginning (MM DD YY) for Charitable Contributions on Page 18 of the instructions and enter the tax credit on Line 20b ) For direct deposit file electronically Go to www dornc com and click on efile for your filing status (Married filing jointly/qualifying widow(er) $100 000; Head of Household $80 000; Single $60 000; or Married filing separately Full year residents enter the amount from Line 15 Full year residents enter this amount here and on Line 15 below Full year residents enter this amount here and on Line 25 of Form D 400 Gleaned CropsProperty Taxes on Farm Machinery Head of Household4 Home Telephone Number (Include area code ) I certify that to the best of my knowledge this return is If prepared by a person other than taxpayer this certification is If a Joint Return Spouse s First Name M I If No complete Lines 1 through 15 Then go to Page 4 of Form D 400 If REFUND mail If return is for a deceased taxpayer or deceased spouse enter date of death If you are entitled to claim the federal child tax credit and your federal adjusted gross income (Form D 400 Line 6) is less than the following amounts shown If you ARE NOT due a If you claim a partnership payment on Line 24c If you claim a tax credit on Line 19 or 25 of Form D 400 you must attach this form to the return If you do not the tax credit may be disallowed if you enter an amount on this line) IMPORTANT: Do not enter the amount from your federal return IMPORTANT: Do not send a photocopy of this form included on your federal return Individual Income Last Name (First 10 Characters) Tax Year Your Social Security Number Last Name (First 10 Characters) Your Social Security Number Last Name (First 10 Characters) Your Social Security Number Line 15; or 1040EZ Line 4 while a resident of North Carolina adjusted by the applicable additions Line 9 by the applicable decimal amount in Column A of the table and enter the result here ) Mailing Address Apartment Number Married Filing Jointly2 Married Filing Separately3 Multiply Line 38 by 4 5% ( 045) Multiply the amount on Line 11 by the applicable decimal amount in Column B of the table N C DEPT OF REVENUE N C local government or federal government retirees N C personal exemption allowance (See instructions on Page 9)13 13 Name(Enter your spouse sfull name and Social NC 478 is attached North Carolina Department of Revenue not accept a check money order or cashier s check unless it is drawn on a U S (domestic) bank and the funds Number of eligible of Exemptionsclaimed on yourfederal income online or by payment voucher mail a check or money order with your return for the full amount due Please write Online You can pay your tax online by bank draft credit or debit card using Visa or MasterCard Go to or for any portion of Line 38 or 51 that does not relate to gross income (If Line 1 is negative fill in circle ) or more use the Tax Rate Schedule on Page 30 to calculate your tax or S corporation payment on Line 24d you must Original Return Payment Options P O BOX 25000 P O BOX R Page 2 Page 3 Page 4 Paid Preparer s Signature Date Part 1 Credit for Income Tax Paid to Another State or Country N C Residents Only You must attach a copy of the return filed with the other state or country Part 2 Credit for Child and Dependent Care Expenses Part 3 Credit for Children (Important: This credit can be claimed only for a dependent child who was under 17 years of age on the last day of the tax year ) Part 4 Other Tax Credits (Limited to the amount of tax) Part 4 Other Tax Credits (Limited to the amount of tax) (continued) Part 5 Earned Income Tax Credit (Not limited to the amount of tax) Part year residents and nonresidents multiply amount on Line 15 by the decimal amount on Line 16 Part year residents and nonresidents multiply the amount on Line 39 by the decimal amount from Form Part year residents and nonresidents must read the instructions on Page 15 and complete the worksheet on Page 16 to determine the amounts to Payment voucher If you do not pay your tax online go to www dornc com and generate a personalized Form Poultry CompostingHandicapped Dwelling Units Preparer s FEIN SSN or PTIN Preparer s Telephone Number (Include area code ) Qualifying Widow(er) with Dependent Child (Year spouse died: )5 RALEIGH NC 27634 0001 RALEIGH NC 27640 0640 refund mail return anypayment and D 400V to: Residency Status Resident/Nonresident Worksheet on Page 16 of the Instructions Retirement Benefits Worksheet on Page 14 and enter the result here return to: Security Number) See Form D 400X for the mailing address and payment options for amended returns See instructions beginning on Page 16 seven and dependent(s) who were physically or mentally incapable of caring for themselves shown on Lines 34 35 36 and 38 and deductions shown on Lines 40 through 47d and Lines 49 50 Sign Here Single1 social security number(s) social security numbers on your payment in the order that they appear on the return Note: The Department will special education (See instructions on Page 19 ) Spouse Spouse (MM DD YY)Taxpayer (MM DD YY) Spouse s Last Name Spouse s Signature (If filing joint return both must sign ) Spouse s Social Security Number Staple Staple W 2s Here Subtract Line 11 from Line 10 12 12 Subtract Line 13 from Line 1214 14 tax return Tax Return 2013 Tax Year than 1 0000 enter the amount from Line 39 here and on Line 25 of Form D 400 The amount on this line may not exceed the tax shown on Form D 400 Line 18 the credit must be prorated based on the ratio of income subject to North Carolina tax to total federal income the tax credit approval letter that you received from the Department of Revenue ) Then complete the Worksheet for Determining Tax Credit to four decimal places ) to your return or to each other wage and tax statement(s) in lower left hand Was your spouse a resident for the entire year? Web Fill Were you a resident of N C for the entire year of 2013? www dornc com and click on Electronic Services for details Yes No You are allowed a credit equal to 4 5% of the Earned Income Tax Credit allowed on your federal return For part year residents and nonresidents You can pay online Go to www dornc com and click on Electronic Services for details You must enter your You Spouse Your Last Name Your First Name(USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS) M I Your Return Here Your Signature Date Your Social Security Number Zip Code Country (If not U S )City State County (Enter first five letters)