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    4             INDIVIDUAL INCOME TAX RETURN
    5             NORTH DAKOTA OFFICE OF STATE TAX COMMISSIONER                                                                                                                 5
    6                                                                                                                                                                           6
    7             SFN 28702 (12-2021)                                                                                                                    FORM ND-1              7
    8                                                                                                                                                                           8
    9                                                                                                                                                    2021                   9
    10                                                                                                                    If a fiscal year filer, enter                        10
         SSN-99-9999                   SSN-99-9999                                                                                                       MM/DD/  YYYY
    11                                                                Deceased:     Date of death:                         fiscal year end:                                     11
    12                                                                                                                                                   Amended: General       12
         PRIMARY(FIRST M LAST)                                            X         MM/DD/    YYYY                         D. Fill in if applicable:                          X
    13   SPOUSE (FIRST M LAST)                                            X                                                 (see instructions)           Amended: Federal NOL X 13
    14                                                                              MM/DD/    YYYY                                                                              14
                                                                                                                           E. Fill in if applicable:         Extension        X
    15                                                                                                                        (see instructions)                                15
         MAILINGADDRESS UNIT# (append unit# to address)
    16   MAILINGADDRESSLINE2                                                                                               F. MN/MT Reciprocity:         X State XX             16
    17                                                                                                                        (see instructions)                                17
         CITY STATE ZIP
    18                                                                                                                                                                          18
         COUNTRY (IF <> USA)
    19                                                                                                                                                                          19
    20     A. Filing status X 1. Single                      X 4. Head of household                                                                                             20
    21       used on               2. Married filing jointly  5. Qualifying widow(er) with                                                                                      21
                            X                                X
    22       federal return:X 3. Married filing separately     dependent child                                                                                                  22
    23                                                                                                                                                                          23
    24   B. School district code:  99-999                                                                                             Reserved for                              24
    25          (see instructions)                                                                                                                                              25
                                                                                                                                      2D Barcode
    26   C. Income source code:                                                                                                                                                 26
                                   99
    27          (see instructions)                                                                                                                                              27
    28                                                                                                                                                                          28
    29     Attach a copy of your entire 2021 federal income tax return.                                                                                                         29
    30                                                                                                                                                                          30
    31     1.a. Federal adjusted gross income from Form 1040 or Form 1040-SR, line 11.  If zero, enter 0.                                (SX) 1a 99999999999999 31
    32                                                                                                                                                                          32
           b. Federal taxable income from Form 1040 or Form 1040-SR, line 15. If zero, see instructions.
    33                                                                                                                                   (SS) 1b     99999999999999 33
    34                                                                                                                                                                          34
    35   Additions                                                                                                                                                              35
    36                                                                                                                                                                          36
    37   2. Lump-sum distribution from Federal Form 4972                                                                       (NA) 2     99999999999999                        37
    38   3. Loss from S corporation taxed as a C corporation                                                                   (NB) 3     99999999999999                        38
    39   4. Planned gift or endowment tax credit adjustment to income                                                          (NK) 4     99999999999999                        39
    40   5.a. Total additions. Add lines 2 through 4                                                                                             5a  99999999999999 40
    41     b. Add lines 1b and 5a                                                                                                                5b  99999999999999 41
    42                                                                                                                                                                          42
    43   Subtractions                                                                                                                                                           43
    44                                                                                                                                                                          44
    45   6. Interest from U.S. obligations                                                                                         (SN) 6 99999999999999                        45
    46   7. Net long-term capital gain exclusion (from worksheet in instructions)                                              (NC) 7     99999999999999                        46
    47   8. Exempt income of an eligible Native American                                                                           (S4) 8 99999999999999                        47
    48   9. Benefits received from U.S. Railroad Retirement Board                                                                  (S5) 9 99999999999999                        48
    49     10. Income from S corporation taxed as a C corporation                                                              (S6) 10 99999999999999                           49
    50   11. Nonresident only:  Servicemembers Civil Relief Act adjustment (Attach copy of Form W-2)                           (NJ) 11    99999999999999                        50
    51   12. North Dakota College SAVE account deduction                                                                       (AA) 12    99999999999999                        51
    52   13. Qualified dividend exclusion                                                                                      (AO) 13    99999999999999                        52
    53   14. Military retirement pay exclusion                                                                                 (AQ) 14    99999999999999                        53
    54   15. Social Security benefit exclusion (see instructions)                                                              (AR) 15    99999999999999                        54
    55                                                                                                                                                                          55
    56                                                                                                                                                                          56
    57   16. Total other subtractions (Attach Schedule ND-1SA)                                                                 (AB) 16 99999999999999                           57
    58                                                                                                                                                                          58
         17. Total subtractions.  Add lines 6 through 16
    59                                                                                                                                           17  99999999999999 59
    60                                                                                                                                                                          60
    61                                                                                                                                   (ND) 18     99999999999999 61
         18. North Dakota taxable income. Subtract line 17 from line 5b.  If less than zero, enter 0
    62                                                                                                                                                                          62
                      NACTP
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    4
                          SSN-XX-XXXX                  SSN-XX-XXXX
    5             2021 FORM ND-1                                                                                                                              5
    6             SFN 28702 (12-2021), Page 2                                                                                                                 6
    7                                                                                                                                                         7
    8                                                                                                                                                         8
    9                                                                                                                                                         9
           19. Tax.  If a full-year resident, enter tax on amount on line 18 from Tax Table in instructions.
    10            If a full-year nonresident or part-year resident, enter tax from Schedule ND-1NR, line 23;              (SB) 19   99999999999999 10
    11            All filers: If you have farm income or sold a research credit, see instructions.                                                            11
    12                                                                                                                                                        12
           20. TAX RELIEF CREDIT - Full-year residents only. If single, head of household, qualifying
    13            widow(er), or  married filing separately, enter $350.  If married filing jointly, enter $700.      (AU) 20 99999999999999                   13
    14                                                                                                                                                        14
    15   Other Credits                                                                                                                                        15
    16     21. Credit for income tax paid to another state or local jurisdiction (Attach Schedule ND-1CR)            (SD) 21 99999999999999                   16
    17     22. Marriage penalty credit for joint filers (See worksheet in instructions)                              (AC) 22 99999999999999                   17
    18     23. Total other credits (Attach Schedule ND-1TC)                                                          (AE) 23 99999999999999                   18
    19     24. Total credits.  Add lines 20 through 23                                                                           24  99999999999999 19
    20     25. Net tax liability.  Subtract line 24 from line 19.  If less than zero, enter 0                                (SE) 25 99999999999999 20
    21                                                                                                                                                        21
    22   Tax Paid                                                                                                                                             22
    23                                                                                                                                                        23
           26. North Dakota income tax withheld from wages and other payments
    24            (Attach W-2s, 1099s, and/or N.D. K-1s)                                                             (SF) 26 99999999999999                   24
    25                                                                                                                                                        25
           27. Estimated tax paid on 2021 Forms ND-1ES and ND-1EXT
    26         plus an overpayment, if any, applied from your 2020 return                                            (S&) 27 99999999999999                   26
    27     28. Total payments. Add lines 26 and 27                                                                        (AJ) 28    99999999999999 27
    28                                                                                                                                                        28
    29   Refund                                                                                                                                               29
    30                                                                                                                                                        30
           29. Overpayment - If line 28 is MORE than line 25, subtract line 25 from line 28;
    31             otherwise, go to line 33.  If less than $5.00, enter 0                                                 (SG) 29    99999999999999 31
    32     30. Amount of line 29 that you want applied to your 2022 estimated tax                                         (SQ) 30    99999999999999 32
    33     31. Voluntary contribution to:         Watchable Wildlife Fund             (SP)            9999999                                                 33
    34                                            Trees for ND Program Trust Fund     (SW) 9999999                                                            34
    35                                            Veterans' Postwar Trust Fund        (AS) 9999999                   Enter total: 31 99999999999999 35
    36                                                                                                                                                        36
    37     32. Refund.  Subtract lines 30 and 31 from line 29.  If less than $5.00, enter 0                                  (SR) 32 99999999999999 37
           To direct deposit your refund, complete 
    38                                              a. Type of account:        XXChecking             Savings                                                 38
    39     items a, b, and c.  (See instructions)   b. Routing Number:         999999999                                                                      39
    40                                              c. Account Number:         99999999999999999                                                              40
    41   Tax Due                                                                                                                                              41
    42     33. Tax due - If line 28 is LESS than line 25, subtract line 28 from line 25. If less than $5.00, enter 0         (SZ) 33 99999999999999 42
    43     34. Penalty    (AK) 99999999999                  Interest      (AL) 99999999999                           Enter total:34  99999999999999 43
    44     35. Voluntary contribution to:         Watchable Wildlife Fund             (SU)            9999999                                                 44
    45                                            Trees for ND Program Trust Fund     (SY)            9999999                                                 45
    46                                            Veterans' Postwar Trust Fund        (AT) 9999999                   Enter total:35  99999999999999 46
    47                                                                                                                           36  99999999999999 47
           36. Balance due. Add lines 33,34, 35, and if applicable, line 37.  Pay to: ND State Tax Commissioner
    48     37. Interest on underpaid estimated tax from Schedule ND-1UT                                              (SO) 37 99999999999999                   48
    49                                                                                                                                                        49
    50                                            1099-G consent - I agree to obtain Form 1099-G electronically at www.nd.gov/tax                             50
    51       Check the boxes that apply:          X                                                                                                           51
             (see instructions)                   X Disclosure Authorization - I authorize the ND Office of State Tax Commissioner to discuss this return
    52                                                 with the paid preparer identified below.                                                               52
    53     I declare that this return is correct and complete to the best of my knowledge and belief.           *Privacy Act - See instructions               53
    54     Your Signature                           Date                  Telephone Number                      This Space Is For Tax Department Use Only     54
    55                                                                    (999) 999-9999                                                                      55
    56     Spouse's Signature                       Date                  Telephone Number                                                                    56
    57                                                                    (999) 999-9999                                                                      57
    58     Paid Preparer Signature                          PTIN                  Date                                                                        58
    59                                                                                                                                                        59
    60     Print Name of Paid Preparer Signature                          Telephone Number                                                                    60
    61                                                                    (999) 999-9999                                                                      61
    62           Attach copy of 2021            Mail to: State Tax Commissioner, PO Box 5621,                                                               62
                  federal income tax return                Bismarck, ND  58506-5621                           IIT
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     INDIVIDUAL INCOME TAX RETURN
     NORTH DAKOTA OFFICE OF STATE TAX COMMISSIONER
     SFN 28702 (12-2021)                                                                                                      FORM ND-1

                                                                                                                              2021
                                                                                               If a fiscal year filer, enter / /
                                                         Deceased:       Date of death:         fiscal year end:
                                                                         / /                    D. Fill in if applicable:     Amended: General
                                                                         / /                         (see instructions)       Amended: Federal NOL
                                                                                                E. Fill in if applicable:     Extension
                                                                                                     (see instructions)
                                                                                                F. MN/MT Reciprocity:         State
                                                                                                     (see instructions)

A. Filing status       1. Single                 4. Head of household
     used on           2. Married filing jointly 5. Qualifying widow(er) with
     federal return:   3. Married filing separately dependent child

B. School district code:      -
     (see instructions)
C. Income source code:
     (see instructions)

Attach a copy of your entire 2021 federal income tax return.

1.a. Federal adjusted gross income from Form 1040 or Form 1040-SR, line 11.  If zero, enter 0.              (SX) 1a

  b. Federal taxable income from Form 1040 or Form 1040-SR, line 15. If zero, see instructions.             (SS) 1b

Additions

2. Lump-sum distribution from Federal Form 4972                                                      (NA) 2
3. Loss from S corporation taxed as a C corporation                                                  (NB) 3
4. Planned gift or endowment tax credit adjustment to income                                         (NK) 4
5.a. Total additions. Add lines 2 through 4                                                                             5a
   b. Add lines 1b and 5a                                                                                               5b

Subtractions

6. Interest from U.S. obligations                                                                    (SN) 6
7. Net long-term capital gain exclusion (from worksheet in instructions)                             (NC) 7
8. Exempt income of an eligible Native American                                                      (S4) 8
9. Benefits received from U.S. Railroad Retirement Board                                             (S5) 9
10. Income from S corporation taxed as a C corporation                                               (S6) 10
11. Nonresident only:  Servicemembers Civil Relief Act adjustment (Attach copy of Form W-2)          (NJ) 11
12. North Dakota College SAVE account deduction                                                      (AA) 12
13. Qualified dividend exclusion                                                                     (AO) 13
14. Military retirement pay exclusion                                                                (AQ) 14
15. Social Security benefit exclusion (see instructions)                                             (AR) 15

16. Total other subtractions (Attach Schedule ND-1SA)                                                (AB) 16

17. Total subtractions.  Add lines 6 through 16                                                                         17

18. North Dakota taxable income. Subtract line 17 from line 5b.  If less than zero, enter 0                 (ND) 18

                                                         www.nd.gov/tax

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2021 FORM ND-1
SFN 28702 (12-2021), Page 2

19. Tax. If a full-year resident, enter tax on amount on line 18 from Tax Table in instructions.
If a full-year nonresident or part-year resident, enter tax from Schedule ND-1NR, line 23; (SB) 19
All filers: If you have farm income or sold a research credit, see instructions.
20. TAX RELIEF CREDIT - Full-year residents only. If single, head of household, qualifying
widow(er), or married filing separately, enter $350. If married filing jointly, enter $700. (AU) 20
Other Credits
21. Credit for income tax paid to another state or local jurisdiction (Attach Schedule ND-1CR) (SD) 21
22. Marriage penalty credit for joint filers (See worksheet in instructions) (AC) 22
23. Total other credits (Attach Schedule ND-1TC) (AE) 23
24. Total credits. Add lines 20 through 23 24
25. Net tax liability. Subtract line 24 from line 19. If less than zero, enter 0 (SE) 25
Tax Paid
26. North Dakota income tax withheld from wages and other payments
(Attach W-2s, 1099s, and/or N.D. K-1s) (SF) 26
27. Estimated tax paid on 2021 Forms ND-1ES and ND-1EXT
plus an overpayment, if any, applied from your 2020 return (S&) 27
28. Total payments. Add lines 26 and 27 (AJ) 28

Refund
29. Overpayment - If line 28 is MORE than line 25, subtract line 25 from line 28;
otherwise, go to line 33. If less than $5.00, enter 0 (SG) 29
30. Amount of line 29 that you want applied to your 2022 estimated tax (SQ) 30
31. Voluntary contribution to: Watchable Wildlife Fund (SP)
Trees for ND Program Trust Fund (SW)
Veterans' Postwar Trust Fund (AS) Enter total: 31

32. Refund. Subtract lines 30 and 31 from line 29. If less than $5.00, enter 0 (SR) 32
To direct deposit your refund, complete a. Type of account: Checking Savings
items a, b, and c. (See instructions) b. Routing Number:
c. Account Number:
Tax Due
33. Tax due - If line 28 is LESS than line 25, subtract line 28 from line 25. If less than $5.00, enter 0 (SZ) 33
34. Penalty (AK) Interest (AL) Enter total:34
35. Voluntary contribution to: Watchable Wildlife Fund (SU)
Trees for ND Program Trust Fund (SY)
Veterans' Postwar Trust Fund (AT) Enter total:35
36. Balance due. Add lines 33,34, 35, and if applicable, line 37. Pay to: ND State Tax Commissioner 36
37. Interest on underpaid estimated tax from Schedule ND-1UT (SO) 37

1099-G consent - I agree to obtain Form 1099-G electronically at www.nd.gov/tax
Check the boxes that apply:
(see instructions) Disclosure Authorization - I authorize the ND Office of State Tax Commissioner to discuss this return
with the paid preparer identified below.
I declare that this return is correct and complete to the best of my knowledge and belief. *Privacy Act - See instructions
Your Signature Date Telephone Number This Space Is For Tax Department Use Only

Spouse's Signature Date Telephone Number

Paid Preparer Signature PTIN Date

Print Name of Paid Preparer Signature Telephone Number

 Attach copy of 2021 Mail to: State Tax Commissioner, PO Box 5621,
federal income tax return Bismarck, ND 58506-5621 IIT

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INDIVIDUAL PAPER RETURN PAYMENT VOUCHER Form ND-1PRV
OFFICE OF STATE TAX COMMISSIONER
SFN 28756 (12-2021)
2021

What is Form ND-1PRV? Office of State Tax Commissioner
The 2021 Form ND-1PRV is a payment voucher that you PO Box 5621
complete and send in with your return if you: Bismarck, ND 58506-5621

● are filing your 2021 Form ND-EZ or Form ND-1 on Only a check drawn on a U.S. or Canadian bank in U.S.
paper, dollars and using a standard 9-digit routing number is
● have a balance due on your return, and accepted.

● are paying the balance due with a paper check or money
Electronic payment option. Instead of paying by check
order.
or money order with this payment voucher, the payment
Do not use Form ND-1PRV if you filed or are going may be made online with an electronic check or a debit
to file your return electronically, or are paying
or credit card. The electronic check option is free. North
a balance due electronically - see “Electronic
payment option.” Dakota contracts with a national payment service to
provide the debit or credit card option, for which there is
Also do not use this form to make an extension
payment; instead, if you have an extension of time a fee, none of which goes to the State of North Dakota. If
to file your Form ND-1 and you want to make an paying electronically, do not use this voucher. To make an
advance payment of an expected balance due on it, electronic payment, go to www.nd.gov/tax/payment.
use Form ND-1EXT.
Need help?
When is the payment due? Phone: 701-328-1242
A balance due on a 2021 Form ND-EZ or 2021 Speech or hearing impaired - 800-366-6888
Form ND-1 must be paid on or before April 15, 2022, to Email: individualtax@nd.gov
avoid any late payment penalty and interest charges.

How to make payment Privacy Act Notification. In compliance with the Privacy Act of 1974,
disclosure of a social security number or Federal Employer Identification
Make your check or money order payable to “ND State Number (FEIN) on this form is required under N.D.C.C. §§ 57-01-15
and 57-38-31, and will be used for tax reporting, identification, and
Tax Commissioner.” Write the last four digits of your administration of North Dakota tax laws. Disclosure is mandatory. Failure
social security number and “2021 ND-1PRV” on your to provide the social security number or FEIN may delay or prevent the
processing of this form.
check or money order. Complete the payment voucher,
detach it from this page, and mail it with your payment
and return to:

▼ Detach here and mail with payment ▼

FORM ND-1PRV INDIVIDUAL PAPER RETURN PAYMENT VOUCHER 2021
North Dakota Office of State Tax Commissioner
SFN 28756 (12-2021)
Do not use this voucher if paying electronically
Name
Social Security
Number . . . . . . . . . . . . .►
Spouse's Name
Spouse's Social
Security Number . . . . . ►
Mailing Address

City, State, ZIP Code
Payment Amount ► $
Mail payment and voucher to: Office of State Tax Commissioner • Make payable to:
PO Box 5621 ND State Tax Commissioner
Bismarck, ND 58506-5621 • Write last four digits of ND-1PRV
social security number and
"2021 ND-1PRV" on check

PDF file checksum: 1743180909

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