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m u . - - Do Not Include This Page RI NC D i NORTH CAROLINA DEPARTMENT OF REVENUE Instructions For Handwritten Forms Before Sending Guidelines Do not use red ink. Use blue or black ink. Printing 8 Do not use dollar signs commas or other punctuation marks. 1 t I ocopies of returns. Submit originals only. Set page scaling to none. The Auto-Rotate and Center checkbox should be unchecked* Do not select print on both sides of paper. c Do not mix form types. NC-4P Web 12-18 Withholding Certificate for Pension or Annuity Payments PURPOSE* Form NC-4P is for North Carolina residents who are recipients of income from pensions annuities and certain other deferred compensation plans. Use the form to tell payers whether you want any State income tax withheld and on what basis. You can also use the form to choose not to have State income tax withheld. However you cannot make this choice for eligible rollover distributions. The method and rate of withholding depends on whether the payment you receive is a periodic payment or a nonperiodic distribution* This form is also to be used by a nonresident with a North Carolina address to indicate that no tax is to be withheld from pension payments. PERIODIC PAYMENTS* Withholding from periodic payments of a pension or annuity is figured in the same manner as withholding from wages. Periodic payments are made in installments at regular intervals over a period of more than one year. They may be paid annually quarterly monthly etc* If you want State income tax withheld you should complete the Form NC-4P Allowance Worksheet. You can designate an additional amount to be withheld on Line 3 of Form NC-4P. Submit the completed form to your payer. If you do not submit Form NC4P to your payer the payer must withhold is Single with no withholding allowances. Caution If you furnish a pension payer a Annuity Payments that contains information which has no reasonable basis and results in a lesser amount of tax being withheld than would have been withheld had you furnished reasonable information you are subject to a penalty of 50 of the amount not properly withheld. You may be subject to interest for underpayment of estimated income tax that applies for not paying enough tax during the year either through withholding or estimated tax payments. New retirees should see Form NC-40 Individual Estimated Income Tax for details on the estimated income tax requirements. You may be able to avoid quarterly estimated income tax payments by having enough tax withheld from your For periodic payments your Form NC-4P stays in effect until you change or revoke it. Your payer must notify you each year of your right to choose not to have State income tax withheld or to revoke your election* NONPERIODIC DISTRIBUTIONS - 4 WITHHOLDING* Your payer must withhold a flat 4 from a nonperiodic distribution unless you choose not to have income tax withheld. A nonperiodic distribution means any distribution which is not a is required on eligible rollover distributions and you cannot choose not to have income tax withheld from those distributions. Distributions from an IRA that are payable on demand are treated as nonperiodic distributions. The election to withhold from nonperiodic distributions applies on a distribution by distribution basis. If you choose not to have tax withheld from a nonperiodic distribution you should check the box on Line 1 of Form NC-4P and submit the completed form to your payer. MISSING OR INCORRECT TAXPAYER IDENTIFICATION NUMBER* If you submit an NC-4P that does not contain the taxpayer identification number or if the identification number is incorrect the payer cannot honor your request not to have income tax withheld. The payer must withhold on Withholding on nonperiodic distributions will be at the 4 rate. REVOKING YOUR NO WITHHOLDING CHOICE* If you previously chose not to have State income tax withheld on either periodic or nonperiodic payments complete another NC-4P and submit to your payer. Write Revoked next to the check box on Line 1 of the form and tax will be withheld at the rate set by law. IMPORTANT. Government retirees whose income is exempt from State tax as a result of the Bailey Settlement should choose no withholding by checking the box on Line 1 Cut here and give this certificate to your employer. Keep the top portion for your records. Type or print your first name and middle initial Home address number and street or rural route City or town state and ZIP code Last name Your social security number Claim or identification number if any of your pension or annuity contract Complete the following applicable lines 1 Check here if you do not want any State income tax withheld from your pension or annuity. Do not complete Lines 2 or 3. 2 Total number of allowances you are claiming for withholding from each periodic Filing status Single or Married Filing Separately Married Filing Jointly or Surviving Spouse Head of Household 3 Additional amount if any you want withheld from each pension or annuity payment. Note For periodic payments you cannot enter an amount here without entering the number including zero of allowances on Line 2.................................. Your Signature Date Enter number of allowances NC-4P Allowance Worksheet Part I Answer all of the following questions for your filing status. Single 1. Will your N*C. itemized deductions from Page 3 Schedule 1 exceed 12 499 3. Will you have federal adjustments or State deductions from income 4. Will you be able to claim any N*C. tax credits or tax credit carryovers Yes o No o If you answered No to all of the above STOP HERE and enter ZERO 0 as total allowances on Form NC-4P Line 2. additional allowances. Otherwise enter ZERO 0 on Form NC-4P Line 2. Will your spouse receive combined wages and taxable pensions of less than 7 500 or only retirement benefits not subject to N*C. income tax Yes o No Will your portion of N*C. itemized deductions from Page 3 Schedule 1 exceed 12 499 Page Surviving Spouse 1. allowances. Otherwise enter FOUR 4 on Form NC-4P Line 2. NC-4P Part II . 1. Enter your total estimated N*C. itemized deductions from Page 3 Schedule 1...................................................... 1. 2. Enter the applicable N*C. standard deduction based on your filing status. 10 000 if Single 20 000 if Married Filing Jointly or Surviving Spouse 15 000 if Head of Household ................................................................. 2. 3. Subtract Line 2 from Line 1. If Line 1 is less than Line 2 enter ZERO 0 ............................................................. 3. 4. Enter an estimate of your total N*C. Child Deduction Amount from Page 3 Schedule 2........................................ 4. federal adjusted gross income................................................................................................................................. 5. 6. Add Lines 3 4 and 5............................................................................................................................................... 6. income.................................................................................................................... 8. 9. Add Lines 7 and 8.................................................................................................................................................... 9. 11. Divide the amount on Line 10 by 2 500 . Round down to whole number............................................................. 11. Ex. 3 900 2 500 1.56 rounds down to 1 12. Enter the amount of your estimated N*C. tax credits............................................ 12. Ex. 200 134 1.49 rounds down to 1 4. If filing as Single Head of Household or Married Filing Separately enter zero 0 on this line. If filing as Surviving Spouse enter 4. If filing as Married Filing Jointly enter the appropriate number from either a b c d or e below. a b d e Your spouse expects to have zero wages and expects to receive retirement benefits that will all be nontaxable for N*C. purposes enter 4. Nontaxable retirement benefits include Bailey Social Security and Railroad retirement to 2 500 enter 3. equal to 5 000 enter 2. 7 500 enter 0..............................................................................................................................................14. 15. Add Lines 11 13 and 14 and enter the total here.................................................................................................. 15. 6. If you completed this worksheet on the basis of Married Filing Jointly the total number of allowances determined on Line 15 may be split between you and your spouse however you choose. Enter the number of allowances from Line 15 that your spouse plans to claim*......................................................................................................... 16. Form NC-4P Withholding Certificate for Pension or Annuity Payments......................................................... 17. Important If you cannot reasonably estimate the amount to enter in the schedules below you should enter ZERO 0 on Line 1 NC-4P. Schedule 1 Estimated N*C. Itemized Deductions Qualifying mortgage interest Real estate property taxes Total qualifying mortgage interest and real estate property taxes Charitable Contributions Same as allowed for federal purposes Medical and Dental Expenses Same as allowed for federal purposes Total estimated N*C. itemized deductions. Enter on Page 2 Part II Line 1 The sum of your qualified mortgage interest and real estate property taxes may not exceed 20 000. For married taxpayers the 20 000 limitation applies to the combined total of qualified mortgage interest and real estate property taxes claimed by both spouses rather than to each spouse separately. A taxpayer who is allowed a federal child tax credit under section 24 of the Internal Revenue Code is allowed a deduction for each dependent child unless adjusted gross income exceeds the threshold amount shown below. The N*C. Child Deduction Amount can be claimed only for a child who is under 17 years of age on the last day of the year. Deduction No* of Amount per Adjusted Gross Income Children Qualifying Child Up to Over MFJ or SS Up to 40 000 Over 40 000 Up to 60 000 Over 100 000 Up to 120 000 Over 120 000 HOH MFS 20 000 20 000 Up to 30 000 Estimated 1 500 30 000 Up to 45 000 45 000 Up to 60 000 Jobs Table Find the amount of your estimated annual wages from your job s in the left hand column* Follow across to find the amount of additional tax to be withheld for each pay period. Enter the additional amount to be withheld on Line 3 of your Form NC-4P. Additional Withholding for Single Married or Surviving Spouse with Jobs Estimated Annual Wages Payroll Period At Least But Less Than Monthly Semimonthly Biweekly Weekly 0 1000 2 1 1 1 1000 2000 7 3 3 2 2000 3000 11 6 5 3 3000 4000 16 8 7 4 4000 5000 20 10 9 5 5000 6000 25 12 11 6 6000 7000 29 14 13 7 7000 8000 33 17 15 8 8000 9000 38 19 17 9 9000 10000 42 21 20 10 10000 Unlimited 10000 11000 47 23 22 11 11000 12000 51 26 24 12 12000 13000 56 28 26 13 13000 14000 60 30 28 14 14000 15000 65 32 30 15 15000 Unlimited 67 33 31 15.

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