Form RO-1062 at a glance
What it is: Form RO-1062 (Rev. 5-19) is the N.C Department of Revenue Collection Information Statement for Individuals.
Who signs: Sign on Your signature line and, if a joint return was filed, on the Spouse's signature line.
What to bring and attach to Form RO-1062
Attachments Required for Wage Earners and Self-Employed Individuals are copies of the following items for the last 3 months from the date this form is submitted (check all the attached items).
Income: Earnings statements, pay stubs, etc. from each employer, pension/social security/other income, self employment income (commissions, invoices, sales, records, etc. and business financial statement if self-employed.)
Banks, Investments, and Life Insurance: Statements for all money market, brokerage, checking and savings accounts, certificates of deposit, IRA, stocks/bonds, and life insurance policies with a cash value.
Assets: Statements from lenders on loans (i.e: mortgage statements, car loans), monthly payments, payoffs, and balances for all personal and business assets. Include copies of UCC financing statements and accountant's depreciation schedules.
Expenses: Bills or statements for monthly recurring expenses of utilities, rent, insurance, property taxes, phone and cell phone, insurance premiums, court orders requiring payments (child support, alimony, etc.), other out of pocket expenses.
Other: credit card statements, profit and loss statements, all loan payoffs, etc.
A copy of the last 2 year's Form 1040 with all attachments. Include all Schedules K-1 from Form 1120S or Form 1065, as applicable.
A filled-in Form RO-1062 example: a married couple fills in page 1
How to fill out Form RO-1062, box by box
Section 1. Personal Information
Enter the Taxpayers' names and address (including County) in box 1, the number of years at the address, and mark Own or Rent.
Enter the Home phone number (2a), the Cell phone number (2b) and the Business phone number (2c).
Enter the Taxpayer's social security number (3a) and the Spouse's social security number (3b).
Enter the Taxpayer's date of birth (4a) and the Spouse's date of birth (4b).
In box 5: Do you have a power of attorney for tax matters? Mark yes or no. If yes, please attach a copy.
Under Marital Status, mark married or unmarried (single, divorced, widowed). The yes and no boxes are for the power of attorney in box 5.
Write the Age and relationship of dependents (exclude yourself and spouse) living in your household.
Section 2. Employment Information
In Section 2. Employment Information, for the Taxpayer's employer or business (name and address) in box 7, write How long employed (7a), Number of exemptions claimed on Form NC-4 (7b), Occupation (7c) and Paydays (7d), and check appropriate box (7e): Wage earner, Sole proprietor or Partner/Member. For the Spouse's employer or business (name and address) in box 8, write How long employed (8a), Number of exemptions claimed on Form NC-4 (8b), Occupation (8c) and Paydays (8d), check appropriate box (8e): Wage earner, Sole proprietor or Partner/Member, and the Business phone #. Enter the Latest filed income tax return (tax year) in box 9, the Number of exemptions claimed in box 10 and the Adjusted Gross Income in box 11.
Section 3 Liquid Assets
Enter the Total Cash on Hand and include cash that is not in the bank.
For Bank accounts (Include Savings & Loans, Credit Unions, Certificates of Deposits, Paypal accounts, Apple Pay accounts etc.), write the Name of Institution, Address, Type of Account, Account No. and 3 month average ending balance, then the Total.
14. Virtual Currency/Cryptocurrency
For Virtual Currency/Cryptocurrency (Bitcoin, Litecoin, etc), write the Type of Virtual Currency, the Name of Virtual Currency Wallet, Exchange or Digital Currency Exchange, the Location(s) of Virtual Currency (Mobile Wallet, Online and/or External Hardware storage) and the Virtual Currency amount and value in dollars, 3 month average, then the Total (14e).
15. Investment Accounts
In 15. Investment Accounts, include stocks, bonds, mutual funds, stock options, certificates of deposit, & retirement assets such as IRAs, Keogh, & 401(k) plans. Write the Type of Investment or Financial Interest, the Full Name & Address (City, State, Zip Code), the Current Market Value, the Loan Balance (if applicable) as of mm/dd/yyyy and the Equity Value Minus Loan (15a to 15c), then the Total Equity (15d): Add lines 15a through 15c and amounts from any attachments.
16. Life Insurance
For 16. Life Insurance, write the Name of Company, Policy Number, Type, Face Amount and Available Cash Value.
Section 4 Real Property
Include all real property and land contracts, owned, rented, and leased (for personal and business use if sole proprietor).
For 17, the Primary Residence (17a) and each Property Description (17b), write the Purchase/Lease Date, County Tax Value, Current Fair Market Value (FMV), Current Loan Balance, Amount of Monthly Payment, Date of Final Payment, Equity (FMV minus loan), Property Location, Lender/Lessor/Landlord Name, Address, Property County and Landlord/Lessor Phone Number.
Add the Total Fair Market Value (17c), Total Current Loan Balance (17d) and Net Equity (17e).
Section 5. Licensed Assets/Vehicles
For 18. Vehicles Purchased and Vehicles Leased, include boats, RVs, motorcycles, trailers, mobile homes, aircraft, etc. (for personal and business use if sole proprietor). Attach additional sheets as needed.
For each of 18a, 18b and 18g, write the Description (Make, Model, Year, Mileage), Purchase/Lease Date, Current Fair Market Value (FMV), Current Loan Balance, Amount of Monthly Payment, Date of Final Payment, Equity (FMV minus loan) and the Lender/Lessor Name, Address.
Add the Total Current Fair Market Value (18c), Total Current Loan Balance (18d) and Net Equity (18e).
Section 6. Other Personal Assets
For 19. Other Assets (Include all assets listed on homeowners insurance policy), write the Description of Asset, Market Value, Balance Due, Monthly Payment and Name and Address of Lien/Note Holder/Obligee, then the Total Current Fair Market Value (19d), Total Current Loan Balance (19e) and Net Equity (19f).
Section 7. Judgments & Secured Liens
For 20. Other Liabilities (Include judgments and any secured debt), write the Description, Amount of Liabilities, Balance Due, Monthly Payment, Name and Address of Lien/Note Holder/Obligee, Date Pledged and Date of Final Payment (20a to 20d).
Section 8. Notes, Charge Accounts and Medical Expenses
For 21. Available Credit (list bank charge cards, credit unions, lines of credit, medical expenses), write the Type of Account or Card, Name and Address of Financial Institution, Monthly Payment, Credit Limit, Amount Owed and Credit Available (21a to 21e).
Section 9. Other Financial Information
Under Other information relating to your financial condition, mark Yes or No for Court proceedings, Bankruptcies, Repossessions, Recent transfer of assets for less than full value, Anticipated increase in income, Participant or beneficiary to trust, estate, profit sharing, etc., Do you receive government assistance based on disability and/or financial need? and Are all required state tax returns filed? If you check the yes box, please give dates and explain under remarks.
Section 10. Monthly Income and Expense Analysis
Enter the Number in Household, County, # Cars and # Car Loans.
Under INCOME, enter the Net for each Source: Wages/Salaries (Taxpayer), Wages/Salaries (Spouse), Rent paid to taxpayer, Other members of household, Pension(s), Social Security, Profit from Business, Commissions and Other Income, then the Total Income.
Attach copy of most recent pay stub for Wages/Salaries (Taxpayer) and Wages/Salaries (Spouse).
Under NECESSARY LIVING EXPENSES, enter the Amount for each Source: Mortgage/Rent, Utilities (Telephone/Cell, Electricity, Heating, Water/Garbage), Homeowner/renter insurance, Groceries, Gas/Maintenance, Auto Insurance, Auto loans, Health/Life Insurance, Medical, IRS Tax Payments and Miscellaneous Payments (Child Support, Alimony, Daycare, Estimated tax), then the Total Expenses.
Calculated Disposable Income is total income less total expenses.
Certification and signature
By signing you certify that, under penalties of perjury and to the best of your knowledge and belief, this Certification statement of assets, liabilities, and other information is true, correct and complete.
Enter the Date.
Section 11. Business Information
Sections 11 and 12 must be completed only if the taxpayer is SELF-EMPLOYED.
49. Is the business a sole proprietorship (filing Schedule C)? If Yes, continue with Sections 11 and 12. If No, complete Business Financial Statement: all other business entities, including limited liability companies, partnerships or corporations, must complete business financial statement.
Section 12. Sole Proprietorship Information
Complete Section 12 only if the taxpayer is SELF-EMPLOYED, and lines 63 through 83 should reconcile with business Profit and Loss Statement. Mark the Accounting Method Used, Cash or Accrual, and write the period for Income and Expenses (mm/dd/yyyy) to (mm/dd/yyyy).
More rules for Form RO-1062
Complete all blocks, except shaded areas. Write "N/A" (not applicable) in those blocks that do not apply.
Expenses not generally allowed are tuition for private schools, public or private college expenses, charitable contributions, voluntary retirement contributions, payments on unsecured debts such as credit card bills, cable television and other similar expenses. However, these expenses may be allowed if it is proven that they are necessary for the health and welfare of the individual or family or for the production of income.
Sources
[1] Form RO-1062 (Rev. 5-19), Collection Information Statement for Individuals, N.C. Department of Revenue (the Official source link on this page).