2019 Debt Setoff Registration Form

Enter all information as you normally would, save, and send to Jennifer Shiflett : Jennifer.shiflett@ncdor.gov

Please note the following:

• For Primary and Secondary contact person – please fill this out. We do not provide this to the public, but we need this in order to contact your agency. As the box indicates it is for internal NCDOR use only.

• Also, the OSC that you provide will be compiled and furnished to OSC for their report.

Please submit this information as soon as possible.