Form Nc-3 (Fl) - Annual Withholding Reconciliation
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Annual Withholding Reconciliation
NC-3 (FL)
North Carolina Department of Revenue
8-26-02
Quarter Ending
N.C. Income Tax Withheld
(Account ID-Enter 9 digits)
(Enter as YYYY)
Account ID
Tax Year
00000000.00
1. March 31
176453458
0000
2. June 30
00000000.00
00000000.00
3. September 30
ALEXANDER
K
MCALLISTER
4. December 31
00000000.00
MICHELLE
Q
MCALLISTER
5. Total Tax Withheld
00000000.00
5121 VALDEZ
CTXXXXXXXXXXXXXXXX35MAX
00000000.00
6a. Tax Withheld Per W-2 Statements
RALEIGHXXXXXXXX20MAX
NC
27605
6b. Tax Withheld Per 1099 Statements
00000000.00
$
7. Total Tax Withheld Per Statements
00000000.00
Signature:
Date:
I certify that, to the best of my knowledge, this return is accurate and complete.
(
)
Title:
Phone:
Mail to: NCDOR, PO Box 25000, Raleigh, NC 27640-0001
20036 999999999X 0000000 06190
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