Form D 400V – Fill Out and Use This PDF

What Is Form D-400V and Why Should You Use It?

It is a statement you send with your payment of any balance due on your 2012 Form D-400. Using Form D-400V allows N.C. to process

your payment more accurately and eficiently. We strongly encourage

you to use Form D-400V.

Preparing and Sending Your Payment

Make your check or money order payable in U.S. dollars to the

NC Department of Revenue.

Note: The Department will not accept a check, money order, or cashier’s check unless it is drawn on a U.S. (domestic) bank and the funds are payable in U.S. dollars.

Make sure your name and address appear on your check or money order.

Enter “2012 Form D-400,” your daytime phone number, and your SSN on your check or money order. If you are

filing a joint return, enter the SSN shown irst on your

return.

What if You File

Electronically?

If you choose to ile electronically

and have a balance due, follow your transmitter’s or preparer’s instructions for making your payment.

Other Payment Methods

In lieu of using the payment voucher below, you may pay your tax online by bank draft, or debit or credit card using Visa or Mastercard. For details, go to our website at www.dornc.com and click on Electronic Services.

Important Reminders

Do not staple, tape, paper clip or otherwise attach your check or money order to the voucher

Do not fold the voucher or check

Do not use the voucher to pay quarterly estimated tax

Do not use a photocopy of the voucher

Do not use another person’s voucher

Do not send cash

D-400V (27)

Individual Income Payment Voucher

Taxpayer/Paid Preparer:

0000000

$ .00

7270127006

Mail to:

NCDOR, PO Box 25000,

Raleigh, NC 27640-0640