Staple All Pages of Your Return Here.
Fill in circle. (See instructions.)
Tax Return 2016
IMPORTANT: Do not send a photocopy of this form.
Your Social Security Number Spouse’s Social Security Number
For calendar year 2016, or scal year beginning and ending (MM-DD-YY)
You must enter your
social security number(s).
Your Last NameYour First Name
(USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS)
Staple W-2s Here.
Married Filing Jointly
(Enter your spouse’s
full name and Social
Married Filing Separately
Head of Household
Qualifying Widow(er) with Dependent Child
(Year spouse died:
Deceased Taxpayer Information
Fill in circle if return is led and signed by Executor,
Administrator or Court-Appointed Personal Representative.
Enter date of death of deceased taxpayer or deceased spouse.
Was your spouse a resident for the entire year?
If No, complete Lines 1 through 12. Then go to
Part D of Schedule S. Fill in residency information
and complete Lines 24 through 26.
Were you a resident of N.C. for the entire year of 2016?
Fill in circle if you or, if married ling jointly, your spouse were out of the country on April 15 and a U.S. citizen or resident.
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 $ .
To designate your overpayment to the Fund, enter the amount of your designation on Page 2, Line 31. See instructions for information about the Fund.
Did you claim the standard deduction on your 2016 federal return?
Fill in one circle only. (See instructions.)
Enter Whole U.S. Dollars Only
Spouse’s Last NameIf a Joint Return, Spouse’s First Name
Country (If not U.S.)
City State County
(Enter rst ve letters)
Part-year residents and nonresidents
(From Line 26 of Form D-400 Schedule S, Part D)
6. Adjusted gross income from your federal return
(If negative, see instructions.)
7. Additions to federal adjusted gross income
(From Line 6 of Form D-400 Schedule S, Part A)
9. Deductions from federal adjusted gross income
(From Line 14 of Form D-400 Schedule S, Part B)
8. Add Lines 6 and 7. 8.
10. Subtract Line 9 from Line 8. 10.
Subtract Line 11 from Line 10.12.
11. N.C. standard deduction OR N.C. itemized deductions
Fill in one circle only. (If itemizing, complete Part C of Form D-400
Schedule S, and enter the amount from Line 23.)
North Carolina Taxable Income
Full-year residents enter the amount from Line 12.
Part-year residents and nonresidents multiply amount on Line 12 by the
decimal amount on Line 13.
15. North Carolina Income Tax
To calculate your tax, multiply Line 14 by 5.75% (0.0575). If Line 14 is
negative, enter -0- on Line 15.
Is your spouse a veteran?
Are you a veteran?