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This form is to be filed by qualified entities as permitted in N.C. Gen. Stat. § § 105-164.14(b) and 105-164.14(c).  This form corresponds with filing periods beginning July 2017 and Forward.

An Excise Tax claim for refund used to obtain a refund for motor fuel used in a qualified Special Mobile Equipment.

 

 

To be used by self-insured workers' compensation corporations in making installment payments of gross premiums tax for 2018

To be used by property and casualty companies in making installment payments of gross premiums tax for 2018

To be used by life, accident, health and title companies in making installment payments of gross premiums tax for 2018

To be used by self-insured workers' compensation groups, health maintenance organizations, and hospital or dental service corporations in making installment payments of gross premiums tax for 2018

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