Fillable NC 5Q Web Fill 0 (North Carolina)

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NC 5Q Web Fill 0 (North Carolina)

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This form must be led on or before the last day of the month following the close of the quarter.
Business Name and Address
City
Legal Name
(USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS)
Street Address
State
Zip Code (5 Digit)
Do not send payment with this
form. Use Form NC-5PX to pay
additional tax and interest.
Date Quarter EndedAccount ID
(MM-DD-YY)
This return is for semiweekly payers only.
If Line 1 is less than Line 2, subtract and enter overpayment
The overpayment will be refunded
4.
If Line 1 is more than Line 2, subtract
and enter underpayment
3.
Total payments to North Carolina for quarter2.
1. Total tax required to be withheld
(From Line IV on reverse of this form)
MAIL TO: North Carolina Department of Revenue, Post Ofce Box 25000, Raleigh, North Carolina 27640-0605
I certify that, to the best of my knowledge, this return is accurate and complete.
Signature:
Date:
Title:
Phone:
Quarterly Income Tax Withholding Return
NC-5Q
Web-Fill
9-19
DOR
Use
Only
4
PRINT
✖
CLEAR
Complete this schedule by entering the N.C. income tax required to be withheld each payday, not payments.
Employer’s Record of State Tax Liability
See NC-30 for more information about withholding tax returns.
I. Tax Withheld - First Month of Quarter
II. Tax Withheld - Second Month of Quarter
III. Tax Withheld - Third Month of Quarter
I.
II.
I. Total tax required to be withheld for rst month of quarter
II. Total tax required to be withheld for second month of quarter
III. Total tax required to be withheld for third month of quarter
IV. Total for Quarter
(Add Lines I, II, and III; enter here and on Line 1 on front)
III.
I V.
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Legal Name (First 10 Characters) Account ID
Page 2
NC-5Q
Web-Fill
9-19
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NC 5Q Web Fill 0 (North Carolina)

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Completed 8 June 2021

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