Fillable 2019 D-400 Schedule PN Webfill (North Carolina)

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2019 D-400 Schedule PN Webfill (North Carolina)

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If you complete Schedule PN, you MUST attach the schedule to Form D-400. If you do not, the Department may be unable to process your return.
Part B. Allocation of Income for Part-Year Residents and Nonresidents
2019 Part-Year Resident
and Nonresident Schedule
D-400 Schedule PN
Total Income
A part-year resident or a nonresident who receives income from N.C. sources must complete this form to determine the percentage of total
income from all sources that is subject to N.C. tax. You are a “part-year resident” if you moved to N.C. and became a resident during the
tax year, or you moved out of N.C. and became a resident of another state during the tax year. You are a “nonresident” if you were not a
resident of N.C. at any time during the tax year.
Taxpayer is: (Fill in applicable circle)
Full-Year Resident
Nonresident
Part-Year Resident
If you and your spouse were both full-year residents of N.C., stop here; do not complete Parts B and C. Do not attach Schedule PN to Form D-400.
Part A. Residency Status
Spouse is: (Fill in applicable circle)
Date N.C. residency began Date N.C. residency ended
(MM-DD-YY) (MM-DD-YY)
Full-Year Resident
Nonresident
Part-Year Resident
Date N.C. residency began Date N.C. residency ended
(MM-DD-YY) (MM-DD-YY)
Do not send a photocopy of this form.
Your Social Security Number
Last Name (First 10 Characters)
Print in Black or Blue Ink Only. No Pencil or Red Ink.
Important: Refer to the Instructions before completing this form.
1. Wages, salaries, tips, etc. 1.
2. Taxable interest 2.
3. Taxable dividends 3.
Taxable refunds, credits, or offsets
of state and local income taxes
4.
4.
5. Alimony received 5.
6. Business income or (loss) 6.
7. Capital gain or (loss) 7.
8. Other gains or (losses) 8.
9. Taxable amount of IRA distributions 9.
10. Taxable amount of pensions
and annuities
10.
Rental real estate, royalties, partnerships,
S-Corps, estates, trusts, etc.
11.
11.
Farm income or (loss)12. 12.
Unemployment compensation13. 13.
14. Taxable amount of Social Security benets
or Railroad Retirement benets
14.
Other income15. 15.
Total Income (Add Lines 1 through 15)16. 16.
COLUMN B
Amount of Column A
subject to N.C. tax
COLUMN A
Total Income
from all sources
DOR
Use
Only
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9-19
DO NOT HANDWRITE ON THIS FORM
4
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✖
CLEAR
DO NOT HANDWRITE ON THIS FORM
Last Name (First 10 Characters)
Your Social Security Number
Tax Year
North Carolina Adjustments
17.
Part B. Allocation of Income for Part-Year Residents and Nonresidents (continued)
Additions:
a. Interest income from obligations of states other than N.C. 17a.
c. Bonus depreciation 17c.
d. IRC section 179 expense 17d.
e. Other additions to federal adjusted gross income that relate
to gross income
17e.
COLUMN B
Amount of Column A
subject to N.C. tax
COLUMN A
Enter the amount from
Form D-400 Schedule S
Total additions (Add Lines 17a through 17e)18. 18.
Deductions:
19.
a. State and local income tax refund 19a.
b. Interest from obligations of the United
States or United States’ possessions
19b.
c. Taxable portion of Social Security or
Railroad Retirement benets
19c.
d. Bailey retirement benets 19d.
e. Bonus depreciation 19e.
f. IRC section 179 expense 19f.
Part C. Part-Year Residents and Nonresidents Taxable Percentage
24.
24.
Part-year residents and nonresidents
taxable percentage (Divide Line 22 by Line 23)
Enter the result as a decimal amount here and on Form D-400, Line 13.
22.
Enter the amount from Column B, Line 21 22.
Enter the amount from Column A, Line 21 23.
23.
h. Other deductions to federal adjusted gross
income that relate to gross income
19h.
20. Total deductions (Add Lines 19a through 19h) 20.
21.
Total income modied by N.C. adjustments
(Line 16 plus Line 18 minus Line 20)
21.
b. Deferred gains reinvested into an Opportunity Fund under
IRC section 1400Z-2
17b.
g. Recognized IRC section 1400Z-2 gain 19g.
Page 2
D-400 Sch. PN
Web-Fill
9-19
2019
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2019 D-400 Schedule PN Webfill (North Carolina)

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Completed 19 July 2020

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