Forms

The banking forms below can be viewed with Adobe Reader. Once Adobe Reader has been installed on your computer, begin entering the required information in the highlighted fields of the form. 

 

Tab/Accordion Items

To order deposit slips, please send this form as a secure email to SBU.Forms@nctreasurer.com.  

Download Form

Instructions

  • While viewing the form in Adobe Reader, tab through the form and enter the required information in the highlighted fields.
  • All forms require a signature so be sure to print and sign each form being used.
  • Scan the signed form and email it to the designated email address at the top of the form. 
  • If you have any questions on the templates, please call 919-814-3916.
Form Description
Account Transfer Template This form is used to setup a template on CB$ to transfer funds from one STIF to another STIF or from a disbursing to a STIF.
Federal Tax Payment Template This form is used to setup a template on CB$ and Wells Fargo to send a wire to the Wells Fargo account used for funding Federal Tax Withholding payments.
International Wire Template This form is used to setup a template on CB$ and Wells Fargo to send a wire to the Wells Fargo account used for funding international wires.
Investment Subscriptions Template This form is used to setup a template on CB$ to transfer funds from STIF/disbursing account to the NC Treasurer's Long Term Investment Fund account.
NCDOR Tax Payment Template This form is used to setup a template on CB$ to transfer funds from a STIF/disbursing account to the NC Department of Revenue's account.
Wire Transfer Template  This form is used to setup a template on CB$ to transfer funds from DSB or STIF account to an external bank account.

 

Wire In/ACH Form

  • Follow the instructions on the Wire In/ACH Form and complete the required fields.
  • Email form to sbu.forms@nctreasurer.com.
Form Description
Wire In/ACH Form (without journal entry) This form is used for STIF account deposits not available for journal entries in NCFS.

Wire Out Forms

Form Description
USD Wire Out Form This form is used by State agencies and financial institutions that do not have access to CB$ or have a template set up to wire funds from their STIF/disbursing accounts.
International Wire Out Form This form is used by State agencies and universities to send international wires in US dollars and foreign currencies.
International Wire Guide USD This is a reference guide for help with international wires being sent in US dollars.
International Wire Guide Foreign Currency This is a reference guide for help with international wires being sent in foreign currency.

 

If a payee claims they did not receive a check and the check has cleared the agency's account in Core Banking (CB$), the agency should work with the payee to get an original, notarized affidavit.  Then, the agency should send the following 3 items to:

NC Department of State Treasurer
Attn: Banking Operations
3200 Atlantic Ave.
Raleigh, NC 27604

  • The original affidavit should be signed and notarized
  • A brief summary of the situation from the agency
  • A copy of the check, front and back, from Core Banking

Note: The Department of State Treasurer (DST) sends the information to the bank that negotiated the check.  The bank will investigate and either send a check to DST for reimbursement or a denial letter and more information.  This can take generally 30-120 days for results.  DST does not discuss the case with the payee, only the agency's contact, so please do not refer the payee to DST.

Form Description
Affidavit for Altered State Warrant This affidavit is used by State entities when a paid warrant is determined to have been altered.
Affidavit and Indemnity Bond for an Individual This affidavit is used by State entities when the payee of a warrant indicates that he/she has not benefited from the warrant made payable to him/her.
Affidavit and Indemnity Bond for a Business  This affidavit is used by State entities when the payee of a warrant indicates the business has not benefited from the warrant made payable to the company.
Affidavit for Counterfeit State Warrant This affidavit is used by State entities when an item clears an agency account fraudulently, normally due to forged endorsement or altered payee.

 

Instructions

  • While viewing the form in Adobe Reader, tab through the form and enter the required information highlighted fields.
  • All forms require a signature so be sure to print and sign each form being used.
  • Mail the original form to the designated mailing address at the top of the form. 
Form Description
Application for New Disbursing or Short Term Investment Fund (STIF) Account This form is used by State entities applying for a disbursing or STIF account
Signature Card for Disbursing & STIF Account This form is used by State entities with all new Disbursing or STIF accounts or if authorized signers need to be amended.