Form Nc-5500 - Request To Waive Or Reduce Penalties - 1999
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1Request to Waive or Reduce Penalties
NC-5500
North Carolina Department of Revenue
Correspondence Unit
9-99
P.O. Box 1168, Raleigh, NC, 27602
1. Identifying Information
Taxpayer Information:
SSN or FEIN: ____________________
Account ID#:
SSN of spouse (if joint return): ___________________________
Name (legal name, if business): _______________________________________________________
Trade Name (if any): _______________________________________________________________
Address:
_______________________________________________________________
_______________________________________________________________
Daytime Telephone Number: (_____) _____ - _________
Penalty Information:
Type(s) of Tax:
____________________________________________
Period(s):
____________________________________________
Amount of Penalty:
____________________________________________
Notice of Assessment:
____________________________________________
Attach copy of notice to this form or write notice number on this line.
2. Reason for Request
Put an X in any block that applies and provide the information requested. Your request will be denied if
you do not provide the requested information.
Death of taxpayer, taxpayer’s immediate family member, or tax preparer.
Name of deceased:
__________________________________________________________
Date of death: _________________ Relation to taxpayer: _____________________________
Explanation of how death prevented compliance:
Serious and sudden illness of taxpayer, taxpayer’s immediate family member, or tax preparer
that began within 3 months before the due date of the tax for which the penalty was assessed.
Name of ill person:
__________________________________________________________
Type and duration of illness: ____________________________________________________
Explanation of how illness prevented compliance:
__________________________________
____________________________________________________________________________
Natural disaster or accident that destroyed property or records and occurred within the
applicable time period. For disasters addressed in a memo from the Secretary of Revenue or
the Governor of North Carolina, the applicable period is the period set in the memo. For other
disasters and for accidents, the applicable period is 3 months following the date of the disaster
or accident.
Date and type of disaster or accident:
_________________________________________
Has insurance claim been filed?
Yes
No
Name of insurance carrier, if claim filed:
_________________________________________
Explanation of how disaster or accident prevented compliance:
Good Compliance Record. For this reason to apply, you must meet the criteria set out in the
instructions on the back of this page.
3. Signature
You must sign this form unless the only reason you checked is Good Compliance Record.
Taxpayer: _______________________________________ Date:_________________
I certify that, to the best of my knowledge, the information given on this form is accurate and complete.
Title: __________________________ Tax Preparer: __________________________
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