Required Information For Electronic Filing - Complete All 4 Sections Below Per North Dakota Office of State Tax Commissioner Section 1: Federal Information Needed for North Dakota Return multiple forms, use the Add button to enter information from each form separately. Example: If you received two Forms W-2, click the "Add" button next to the Form W-2 and enter the information for your first Form W-2. After completing the first Form W-2, select the Add button again and enter the information for the second Form W-2. Repeat Form W-2 Wage & Tax Statement G Form 1099-R G Form W-2G Certain Gambling Winnings G Form 1099-G Certain Government Payments G Form 1099-MISC Miscellaneous Income G Check the box if you do not have any of the above forms G Section 2: Verifying Your Identity IMPORTANT: Identifying information from your North Dakota return Note: If you are married filing joint, and you filed together in 2012, enter the same amount in the taxpayer and spouse columns. Taxpayer Spouse Prior Year North Dakota Taxable Income . . . . . . . . . . . . . . . . . . . . . Section 3: Additional Information Needed to E-file Your North Dakota Return A. Enter Email Address E-mail address (for confirmation e-mail) . . . . . . . . . . . . . . . . . . Re-enter e-mail address (must match) . . . . . . . . . . . . . . . . . . . . Enter your 2012 North Dakota taxable income (Form ND-1, line 18). The North Dakota Office of State Tax Commissioner uses this information to verify your identity. This information must match what they have in their records, so don't guess. Do not use amounts from an amended 2012 North Dakota tax return. The 2012 taxable income must come from your originally filed tax return. this for each of the types of forms listed below that you received. B. International ACH Transactions - Required if using direct deposit or electronic funds withdrawal Yes No Will the funds go to or originate from an account outside the U.S.? Section 4: Refund/Payment Options B. Paying Tax Due by Check- If you are paying with a check, print form ND-1V payment voucher and mail it with your check to Routing number . . . . . . . . . . . G Account number . . . . . . . . . . G Type: . . . . . . . . . . . . . . . . . . . . . G Date to make withdrawal . G Note: Do not enter direct deposit information here, enter it on Form ND-1. C. Electronic Funds Withdrawal of Tax Due - If you would like to pay your tax balance due using electronic funds withdrawal, enter the required information below. By checking the box and entering the information below, I agree to pay my tax balance due by electronic funds withdrawal Checking Saving If you received a form W-2, 1099-R, W-2G, 1099-G, or 1099-MISC that has North Dakota Witholding on it, you are required to enter specific information for each of the forms received. You must enter the information exactly as it appears on the form. If you have . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Distributions from Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc . . . . . . . . . . . . . . . . . . . Required: the North Dakota Officeof State Tax Commissioner. Check the box to authorize electronic funds withdrawal A. Refund - You will receive a check unless entered direct deposit information directly on Form ND-1. ----------------Page (0) Break----------------