Do not send a photocopy of this form. 2021 N.C. Adjustments for Individuals D-400 Schedule S Your Social Security Number Last Name (First 10 Characters) If you are required to add certain items to federal adjusted gross income on Form D-400, Line 7, or if you are entitled to take deductions from federal adjusted gross income on Form D-400, Line 9, you must complete and attach this schedule to Form D-400. Importantly, you must attach both pages of this schedule to Form D-400, even if you are only required to complete one part of the schedule. If you do not, the Department may be unable to process your return. Print in Black or Blue Ink Only. No Pencil or Red Ink. DOR Use Only Part A. Additions to Federal Adjusted Gross Income (Only add items that are not included in federal adjusted gross income) Total Additions - Add Lines 1 through 14 (Enter the total here and on Form D-400, Line 7) 15. Interest Income From Obligations of States Other Than N.C. 1. Deferred Gains Reinvested Into an Opportunity Fund 2. Bonus Depreciation 3. IRC Section 179 Expense 4. S-Corporation Shareholder Built-in Gains Tax 5. Amount by Which Federal Basis Exceeds State Basis for Property Disposed of in 2021 6. Unabsorbed Net Operating Loss Deduction 7. State, Local, or Foreign Income Tax Deducted by an S Corporation, Partnership, or Estate and Trust 8. Withdrawal of 529 Plan Contributions Not Used for Permissible Purpose 9. Discharge of Qualified Principal Residence Indebtedness 10. Qualified Education Loan Payments Paid by Employer 11. Business Meal Deduction in Excess of 50% 12. Discharge of Certain Student Loan Debt 13. Reserved for Future Use 14. Web-Fill 12-21 15. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. DO NOT HANDWRITE ON THIS FORM DO NOT HANDWRITE ON THIS FORM 4 PRINT  CLEAR

Last Name (First 10 Characters) Your Social Security Number 2021 Tax Year Page 2 D-400 Sch. S Web-Fill 12-21 Gain From the Disposition of Exempt N.C. Obligations Issued Before July 1, 1995 25. Total Deductions - Add Lines 16 through 21, 22f, 23f, and 24 through 37 (Enter the total here and on Form D-400, Line 9) 38. Recognized IRC Section 1400Z-2 Gain 24. Retirement Benefits Received by Vested N.C. State Government, N.C. Local Government, or Federal Government Retirees (Bailey settlement - Important: See instructions) 19. Exempt Income Earned or Received by a Member of a Federally Recognized Indian Tribe 26. Amount by Which State Basis Exceeds Federal Basis for Property Disposed of in 2021 27. Ordinary and Necessary Business Expense Reduced or not Allowed Due to Claiming a Federal Tax Credit in Lieu of a Deduction 28. Personal Education Savings Account Deposits 29. Certain State Emergency Response and Disaster Relief Reserve Fund Payments 30. Certain Economic Incentive Payments 31. Certain Net Operating Loss Carrybacks (Limited to 20% of amount added to AGI in tax years 2013 through 2019) 33. Excess Net Operating Loss Carryforward (Limited to 20% of amount added to AGI in 2019 and 2020) 34. Business Interest Limitation (Limited to 20% of amount added to AGI in 2019 and 2020) 36. Excess Business Loss (Limited to 20% of amount added to AGI in 2018, 2019, and 2020) 35. Reserved for Future Use 37. Certain N.C. Grant Payments 32. State or Local Income Tax Refund Interest Income From Obligations of the United States or United States’ Possessions Taxable Portion of Social Security and Railroad Retirement Benefits 16. 17. 18. Part B. Deductions From Federal Adjusted Gross Income (Only deduct items that are included in federal adjusted gross income) Bonus Asset Basis 21. Bonus Depreciation 22. 22a. 2016 22b. 2017 22c. 2018 22d. 2019 22e. 2020 IRC Section 179 Expense 23. 23a. 2016 23b. 2017 23c. 2018 23d. 2019 23e. 2020 Certain Retirement Benefits Received by a Retired Member of the United States Armed Forces Not Deducted on Line 19 (Important: See instructions to determine if benefits qualify for deduction) 20. 25. 38. 24. 19. 26. 27. 28. 29. 30. 31. 33. 34. 36. 35. 37. 32. 16. 17. 18. 21. 22f. Total (Add Lines 22a -22e) 23f. Total (Add Lines 23a -23e) 20.