CORRECTED (if checked)
PAYER’S name, street address, city, state and ZIP code                                 TAX YEAR
                                                                                                                          Form NC-1099-ITIN 
                                                                                                                          Compensation Paid 
                                                                                                                          to an ITIN Contractor
                                                                                   1.  Gross income paid for services
PAYER’S federal identification number/ RECIPIENT’S individual taxpayer              in North Carolina                                 See #1 in the 
social security number                 identification number                                                                          box below for 
                                                                                                                                      information 
                                                                                     $                                                on the annual 
                                                                                   2.  North Carolina income tax withheld             withholding 
RECIPIENT’S name, address, (incl. apt. no.), city, state and ZIP code                                                                 reconciliation 
                                                                                                                                      requirements.
                                                                                     $                                                Give two copies 
                                                                                   3.  PAYER’S North Carolina withholding account no. to recipient
                                                                                                                                      Keep one copy 
                                                                                                                                      for your records
Form NC-1099-ITIN  Rev. 10-16  (Web)        North Carolina Department of Revenue, P.O. Box 25000, Raleigh, N.C. 27640-0001
                                                                                                                                                    

                                       Form NC-1099-ITIN to be completed by Payer only

                                       Compensation paid to an ITIN Contractor

An ITIN is issued by the IRS to a person who is required to have a taxpayer identification number but does not have and is 
not eligible to obtain a social security number. An ITIN contractor is an ITIN holder who performs services in this State for 
compensation other than wages. North Carolina income tax is required to be withheld from ITIN contractors. The requirement 
to withhold applies to payers who, in the course of a trade or business, pay more than $1,500 of non-wage compensation 
to an ITIN holder for services performed in this State. These payers must withhold North Carolina income tax at the rate 
of four percent (4%) from the compensation. (Note: See                       NC-30, Income Tax Withholding Tables and Instructions for 
Employers, for a more detailed explanation of requirements.)

                                                             Instructions for Payer

Complete this form to report the gross income paid to an ITIN holder for services performed in North Carolina and the North 
Carolina tax withheld from that income. If you are required to complete federal Form 1099-MISC to report the gross income 
paid to an ITIN holder, you do not have to complete this form. Do not use this form to report the payment of wages.

                                                                      The Payer Must
1.  Electronically submit Form NC-3, Annual Withholding Reconciliation, and the corresponding statement 
        information for each           Form W-2 and 1099              to the North Carolina Department of Revenue by                  January 31 of 
        the succeeding year. Please visit the Department’s website at www.dornc.com for additional information.
2.  Furnish two copies to the recipient by January 31 following the calendar year in which the compensation 
        was paid. Include a copy of these instructions with the recipient’s copies of Form NC-1099-ITIN. (Note: If the 
        services are completed before the end of the year, the statement is due within 45 days of the last payment 
        of compensation if the recipient requests the statement.)
3.  Keep a copy for your records.

See the North Carolina Income Tax Withholding Tables and Instructions for Employers (Form NC-30) at www.dornc.com                                      
for additional information.  
                                                       Instructions for Recipient

Withholding of income tax from your personal services income does not relieve you of your responsibility to file a North 
Carolina income tax return. Claim the tax withheld reported in Box 2 against your income tax liability for the year. Attach a 
copy of Form NC-1099-ITIN without the instructions to the income tax return to support North Carolina tax withheld.