
Annual Withholding Reconciliation
NC-3
Web
8-18
North Carolina law requires Form NC-3 and the required statements to be led in an electronic format as prescribed by the Department. Electronic ling
and payment methods are available through the Department’s website at www.ncdor.gov. If you are unable to le Form NC-3 and the required statements
electronically, mail this form and the required statements with your check or money order to: North Carolina Department of Revenue, PO Box 25000,
Raleigh, North Carolina 27640-0001. You will be subject to a penalty for failure to le the form and required statements electronically.
Signature:
Date:
Title:
I certify that, to the best of my knowledge, this claim is accurate and complete.
Street Address
City State Zip Code
FEIN or SSN
(YYYY)
For Calendar Year
(MM-DD-YYYY)
If your business closed or if you stopped paying wages during
the calendar year, enter the nal date you paid wages:
Account ID
Legal Name (First 32 Characters) (USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS)
13. Total Tax Withheld as Reported to the Department
Add Lines 1 through 12. Enter total here and on Line 16.
,,
.
Tax Withheld as Reported on W-2 Statements14.
,,
.
Tax Withheld as Reported on 1099 Statements15.
,,
.
Month Amount
11. November
10. October
8. August
7. July
9. September - End of 3rd Quarter
12. December - End of 4th Quarter
5. May
4. April
2. February
1. January
3. March - End of 1st Quarter
6. June - End of 2nd Quarter
AmountMonth
Enter total tax withheld as reported to the Department for each period
Interest (See the Department’s website, www.ncdor.gov, for current interest rate.)
Multiply Line 19 by applicable rate
20.
.
00
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Additional Tax Due19.
.
00
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Overpayment18.
.
00
,,
00
Amount of Refund Requested - If Line 18 is blank or zero, skip to Line 23. Otherwise, compare Line 18 with
Line 21c. If Line 18 is more than Line 21c, subtract Line 21c from Line 18 and enter the amount of refund
here. If Line 18 is less than Line 21c, subtract Line 18 from Line 21c and enter the amount due on Line 23.
22.
.
,,
21. Informational Return Penalties (See instructions)
Add Lines 21a and 21b and enter the total on Line 21c
a. Failure to File by Due Date
,
.
00
,
.
00
b. Failure to File in Format
Prescribed by the Secretary
00
.
c.
Total Amount Due
Add Lines 19, 20, and 21c
23.
00
.
,,
Pay in U.S. Currency From a Domestic Bank
Total Tax Withheld as Reported on W-2 and 1099 Statements
Add Lines 14 and 15; round to the nearest whole dollar
17.
00
.
,,
16. Total Tax Withheld as Reported to the Department
From Line 13; round to the nearest whole dollar
00
.
,,
Compare Line 16 and Line 17. If Line 16 and Line 17 are the same, skip to Line 21. If Line 16 is more than Line 17, the account
is overpaid. Subtract Line 17 from Line 16 and enter the amount of overpayment on Line 18. If Line 16 is less than Line 17, the
account is underpaid. Subtract Line 16 from Line 17 and enter the amount of tax due on Line 19.
DOR
Use
Only