North Carolina Form 60 PDF Details

Are you a North Carolina resident looking to file an estate tax return? If so, the NC-60 Form is likely your first step. This document outlines important information relating to the estate of a decedent (the deceased) in order to properly calculate and pay taxes due. In this blog post, we will cover everything you need to know about filing your NC-60 form, including how and when it must be filed, what type of information is collected on it, as well as any additional resources that may prove useful in its completion. Let's get started!

QuestionAnswer
Form NameNorth Carolina Form 60
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namescompensable, particularity, RALEIGH, HTTP

Form Preview Example

NORTH CAROLINA INDUSTRIAL COMMISSION

IC File #

EMPLOYERS ADMISSION OF EMPLOYEES RIGHT TO

COMPENSATION (G.S. §97-18(B))

Emp. Code #

Carrier Code # Carrier File #

The Use Of This Form Is Required Under The Provisions of The Workers' Compensation Act

Employer FEIN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

-

 

 

Employee’s Name

 

 

 

 

 

Employer’s Name

 

 

 

Telephone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

Employer’s Address

City

 

 

State

Zip

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

State

 

Zip

Insurance Carrier

Policy Number

 

 

( )

-

 

(

)

-

 

 

 

 

 

 

 

 

 

 

Home Telephone

 

Work Telephone

 

Carrier’s Address

City

 

 

State

Zip

 

-

-

M

F

/

/

 

( )

-

( )

-

 

 

 

 

Social Security Number

Sex

 

Date of Birth

 

Carrier’s Telephone Number

Fax Number

 

 

 

TO DEFENDANTS: Describe with particularity the body part(s) or condition(s) for which you are admitting liability and compensability.

TO EMPLOYEE: Your employer admits your right to compensation for an

injury by accident on /

/

(date) (Specify body part(s) involved):

 

 

 

 

 

occupational disease on

/ /

 

(date) (Specify condition(s) and body part(s) involved):

THE FOLLOWING ITEMS 1 THROUGH 4 ARE PROVIDED FOR INFORMATIONAL PURPOSES ONLY AND DO NOT CONSTITUTE AN AGREEMENT:

1.The description of the injury or occupational disease, including body parts involved is:

2.The employee was paid for the entire day of injury.

Yes

No

3.

The employee's average weekly wage, subject to verification, including overtime and all allowances, was $

, which results

 

in a weekly compensation rate of $

 

.

 

 

 

 

 

 

 

 

 

 

 

a. Temporary total compensation is being paid at the compensation rate above.

 

 

 

b. Temporary partial compensation is being paid in the amount of $

.

 

 

 

 

 

 

c. Other:

 

 

 

 

 

 

 

 

 

 

 

 

 

4.

The disability resulting from the injury began on / /

(date), and compensation commenced on / /

 

(date).

 

 

 

 

 

 

 

 

 

/

 

/

SIGNATURE OF EMPLOYER OR CARRIER/ADMINISTRATOR

 

 

TITLE

DATE

EMPLOYER: Failure to file Form 28B, Report of Compensation and Medical Compensation Paid, within 16 days after last payment pursuant to an agreement or award subjects employer or carrier/administrator to a penalty pursuant to N.C. Gen. Stat. §97-18(h). Form 30 must be used for compensable injuries resulting in death. A copy of this Form 60 shall be provided to the employee and the employee's attorney of record, if any, and the original provided to the Industrial Commission at the address below.

 

 

SELF-INSURED EMPLOYER OR CARRIER MAIL TO:

FORM 60

 

NCIC - CLAIMS ADMINISTRATION

8/1/08

 

4335 MAIL SERVICE CENTER

PAGE 1 OF 1

FORM 60

RALEIGH, NORTH CAROLINA 27699-4335

 

MAIN TELEPHONE: (919) 807-2500

 

 

HELPLINE: (800) 688-8349

 

 

WEBSITE: HTTP://WWW.IC.NC.GOV/