This form must be led on or before the last day of the month following the close of the quarter.
Business Name and Address
(USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS)
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
This return is for semiweekly payers only.
If Line 1 is less than Line 2, subtract and enter overpayment
The overpayment will be refunded
If Line 1 is more than Line 2, subtract
and enter underpayment
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 Ofce Box 25000, Raleigh, North Carolina 27640-0605
I certify that, to the best of my knowledge, this return is accurate and complete.
Quarterly Income Tax Withholding Return