North Carolina Department of Revenue
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Enter Your Information Below, Then Click on "Create Form" to Create the Personalized Form "D-400V Amended, Individual Income Payment Voucher"

Click here for help if the form does not appear after you click "create form".  

     
 
For Calendar Year   Filing Status
 
Primary First Name
MI
Last Name Social Security Number
- -
Spouse First Name
MI
Last Name Social Security Number
- -
Address
City State Zip Code Country (if not U.S.)

 

Payment Amount (whole dollar amounts)
$ .00 Do not print this page.

Use the "Create Form" button located below to generate the printable form.