, 00 . , 00 . , 00 . , 00 . , 00 . , 00 . , 00 . . , 00 . 00 . , Federal Extension Were you granted an automatic extension to file your 2022 federal income tax return, e.g., Form 1040? IMPORTANT: Do not send a photocopy of this form. Your Social Security Number Spouse’s Social Security Number For calendar year 2022, or fiscal year beginning and ending (MM-DD-YY) (MM-DD) Mailing Address Spouse’s Last Name Your Last Name Your First Name (USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS) M.I. If a Joint Return, Spouse’s First Name M.I. Zip Code Country (If not U.S.) City State County (Enter first five letters) Staple All Pages of Your Return Here Staple W-2s Here Apartment Number Married Filing Jointly 2. SSN Name (Enter your spouse’s full name and Social Security Number) Married Filing Separately 3. Head of Household 4. ) 5. Qualifying Widow(er) (Year spouse died: Deceased Taxpayer Information Fill in circle if return is filed and signed by Executor, Administrator, or Court-Appointed Personal Representative. Taxpayer (MM-DD-YY) Enter date of death of deceased taxpayer or deceased spouse. Was your spouse a resident for the entire year? If No, complete and attach Form D-400 Schedule PN. Residency Status Were you a resident of N.C. for the entire year? Fill in circle if you, or if married filing jointly, your spouse were out of the country on April 15, 2023, and a U.S. citizen or resident. N.C. Education Endowment Fund: You may contribute to the N.C. Education Endowment Fund by making a contribution or designating some or all of your overpayment to the Fund. To make a contribution, enclose Form NC-EDU and your payment of $ _______________________________. To designate your overpayment to the Fund, enter the amount of your designation on Page 2, Line 31. (See instructions for information about the Fund.) 2022 Individual Income Tax Return D-400 AMENDED RETURN Fill in circle (See instructions) Single 1. Filing Status (Fill in one circle only) Yes No Yes No Yes No Is your spouse a veteran? Yes No Veteran Information Are you a veteran? You must enter your social security number(s) Print in Black or Blue Ink Only. No Pencil or Red Ink. Enter Whole U.S. Dollars Only 6. 6. Federal Adjusted Gross Income 7. 7. Additions to Federal Adjusted Gross Income (From Form D-400 Schedule S, Part A, Line 16) 9. 9. Deductions From Federal Adjusted Gross Income (From Form D-400 Schedule S, Part B, Line 41) 8. Add Lines 6 and 7 8. If amount on Line 6, 8, 12b, or 14 is negative, fill in circle. Example: 10. 13. Part-year Residents and Nonresidents Taxable Percentage (From Form D-400 Schedule PN, Line 24. Enter amount as decimal.) 13. 14. North Carolina Taxable Income Full-year residents enter the amount from Line 12b. Part-year residents and nonresidents multiply amount on Line 12b by the decimal amount on Line 13. 14. 15. 15. North Carolina Income Tax Multiply Line 14 by 4.99% (0.0499). If zero or less, enter a zero. (Fill in one circle only. See Form D-400 Schedule A.) 11. 11. N.C. Standard Deduction OR N.C. Itemized Deductions Child Deduction (On Line 10a, enter the number of qualifying children for whom you were allowed a federal child tax credit. On Line 10b, enter the amount of the child deduction. See instructions.) 10a. a. Add Lines 9, 10b, and 11. 12. 12b. Subtract Line 12a from Line 8 Yes No DOR Use Only Out of Country , , , , , , , , 00 . , , Web 8-22 2 2 Spouse (MM-DD-YY) 10b.

Last Name (First 10 Characters) Your Social Security Number 2022 Tax Year I declare and certify that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. Add Lines 29 through 32 33. 33. Subtract Line 33 from Line 28. This is the Amount To Be Refunded For direct deposit, file electronically 34. 34. 19. Add Lines 17 and 18 19. 18. Consumer Use Tax (See instructions) If you certify that no Consumer Use Tax is due, fill in circle. 18. Subtract Line 16 from Line 15 17. 17. Other Tax Payments 21. a. 2022 estimated tax 20. a. Your tax withheld North Carolina Income Tax Withheld If you claim a partnership payment on Line 21c or S corporation payment on Line 21d, you must attach a copy of the NC K-1. Amount Due - Add Lines 26a, 26d, and 26e Pay in U.S. Currency from a Domestic Bank - You can pay online at www.ncdor.gov. 27. 27. $ Overpayment - If Line 25 is more than Line 19, subtract Line 19 from Line 25. 28. 28. 30. Contribution to the N.C. Nongame and Endangered Wildlife Fund 30. Amount of Line 28 to be applied to 2023 Estimated Income Tax 29. 29. 26e. a. Tax Due - If Line 25 is less than Line 19, subtract Line 25 from Line 19. Otherwise, go to Line 28. 26. 26a. 26d. (Add Lines 26b and 26c and enter the total on Line 26d.) b. Penalties c. Interest , 00 . , 00 . e. Interest on the Underpayment of Estimated Income Tax (See instructions and enter letter in box, if applicable.) Contribution to the N.C. Education Endowment Fund 31. 31. Subtract Line 24 from Line 23. (If less than zero, see instructions.) 25. 25. Previous Refunds (Amended Returns Only. See instructions) 24. 24. Add Lines 20a through 22 23. Additional Payments (Amended Returns Only. See instructions) 22. 23. 22. If amount on Line 25 is negative, fill in circle. Example: When filing an amended return, see instructions Contribution to the N.C. Breast and Cervical Cancer Control Program 32. 32. If REFUND, mail return to: N.C. DEPT. OF REVENUE, P.O. BOX R, RALEIGH, NC 27634-0001 If you ARE NOT due a refund, mail return, any payment, and D-400V to: N.C. DEPT. OF REVENUE, P.O. BOX 25000, RALEIGH, NC 27640-0640 Contact Phone Number (Include area code) Check here if you authorize the North Carolina Department of Revenue to discuss this return and attachments with the paid preparer below. Your Signature Date Spouse’s Signature (If filing joint return, both must sign.) Date Paid Preparer’s Signature Date If prepared by a person other than taxpayer, this certification is based on all information of which the preparer has any knowledge. Preparer’s FEIN, SSN, or PTIN PAID PREPARER USE ONLY 16. Tax Credits (From Form D-400TC, Part 3, Line 20) 16. 00 . 00 . , , , , , 00 . , , 00 . , 00 . , , 00 . 00 . 00 . 00 . 00 00 . 00 . . , , , , , , , , 00 . , , , , , , , , 00 . , , 00 . , , 00 . , , 00 . , , 00 . , , , 00 . , 00 . , b. Paid with extension 00 . , d. S Corporation 00 . , b. Spouse’s tax withheld , 00 . , , 00 . , , 00 . , , , , c. Partnership Exception to Underpayment of Estimated Tax Preparer’s Contact Phone Number (Include area code) Page 2 D-400 Web 8-22