Free Wv Tax Template

Free Wv Tax Template

The West Virginia Tax Form is a document used by residents to report their personal income and calculate their tax obligations to the state. This form, known as IT-140, must be completed and submitted annually, with the due date typically falling on April 15. Understanding the instructions and requirements of this form is essential for accurate filing.

To begin filling out the form, click the button below.

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When it comes to navigating the intricacies of personal income tax in West Virginia, the 2020 WV Tax Form, specifically the IT-140, plays a pivotal role. This form serves as the foundation for reporting your income, calculating your tax obligations, and ultimately determining any refunds or balances due. Taxpayers must pay close attention to various sections, including the essential filing status options, which range from single to married filing jointly. Each choice can significantly impact your tax calculations. The form also requires you to list exemptions, which can reduce your taxable income, and provides a detailed breakdown of income adjustments through schedules like M and E. Understanding how to accurately report your federal adjusted gross income, along with any additions or subtractions specific to West Virginia, is crucial for compliance and maximizing potential credits, such as the Family Tax Credit. Furthermore, navigating the deadlines, including the due date of April 15, 2021, is essential to avoid penalties. Each line of the form, from income calculations to tax credits and potential refunds, is designed to guide you through the process, ensuring that you meet your tax obligations while taking advantage of available benefits.

Wv Tax Example

2021

Wൾ ඌ ඍ V උ ඀ ඇ ൺ

Personal Income Tax Forms & Instructions

2021 PERSONAL INCOME TAX IS DUE APRIL 18, 2022

WE S T V I R G I N I A S TAT E TA X D E PA RT M E N T

TABLE OF CONTENTS

Schedule UT Instructions

10

Important Information for 2021

13

Tips on Filing a Paper Return

14

General Information

15

Form IT-140 Instructions

19

Schedule M Instructions

21

Schedule A Instructions

24

Schedule E Instructions

26

Form IT-210 Instructions

27

2021

Family Tax Credit Tables

31

2021

West Virginia Tax Table

32

2021

Tax Rate Schedules

37

Index

49

COVER PHOTOGRAPH BY JINDALAY

 

 

IT-140

W

WEST VIRGINIA PERSONAL INCOME TAX RETURN

2021

 

 

 

REV 9-21

 

 

SOCIAL

SECURITY

NUMBER

LAST NAME

SPOUSE’S

LAST NAME

FIRST LINE OF

ADDRESS

CITY

TELEPHONE

NUMBER

Deceased

 

 

*SPOUSE’S

 

 

Deceased

 

 

 

 

 

 

 

SOCIAL SECURITY

 

 

 

 

 

 

 

Date of Death:

 

 

Date of Death:

NUMBER

 

 

 

 

 

 

 

YOUR

 

 

 

 

 

 

 

 

SUFFIX

 

FIRST

 

 

 

 

MI

 

 

 

 

 

NAME

 

 

 

 

 

 

 

 

 

 

SPOUSE’S

 

 

 

 

 

 

 

 

SUFFIX

 

FIRST

 

 

 

 

MI

 

 

 

 

 

NAME

 

 

 

 

 

 

 

 

SECOND LINE

 

 

 

 

 

 

 

 

 

 

OF ADDRESS

 

 

 

 

 

 

 

 

 

 

STATE

 

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMAIL

 

 

EXTENDED DUE DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MM/DD/YYYY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Amended return

Check before 4/18/22 if you wish to stop the original debit (amended return only)

Nonresident Special

Nonresident/ Part-Year Resident

Form WV-8379 filed as an injured spouse

1

2

3

4

5

FILING

STATUS

(Check One)

Single

Head of Household

Married, Filing Joint

Married, Filing

Separate

*Enter spouse’s SS# and name in the boxes above

Widow(er) with dependent child

 

 

 

 

Enter “1” in boxes a

Yourself

(a)

 

Exemptions

(If someone can claim you as a dependent, leave box (a) blank.)

{ Spouse

 

 

and b if they apply

(b)

 

c. List your dependents. If more than five dependents, continue on Schedule DP on page 6.

 

 

 

 

 

First name

 

Last name

Social Security

 

Date of Birth

 

 

 

 

Number

 

(MM DD YYYY)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

d. Additional exemption if surviving spouse (see page 17)

Enter total number of dependents

(c)

Enter decedents SSN: ______________________ Year Spouse Died: _____________________

(d)

e. Total Exemptions (add boxes a, b, c, and d). Enter here and on line 6 below. If box e is zero, enter $500 on line 6 below.

(e)

1.Federal Adjusted Gross Income or income to claim senior citizen tax credit from Schedule SCTC-A

2.Additions to income (line 56 of Schedule M).............................................................................................

3.Subtractions from income (line 48 of Schedule M)....................................................................................

4.West Virginia Adjusted Gross Income (line 1 plus line 2 minus line 3)......................................................

5.Low-Income Earned Income Exclusion (see worksheet on page 23)........................................................

6.Total Exemptions as shown above on Exemption Box (e) ________ x $2,000 ........................................

7.West Virginia Taxable Income (line 4 minus lines 5 & 6) IF LESS THAN ZERO, ENTER ZERO ............

8.Income Tax Due (Check One) .................................................................................................................

Tax Table

 

Rate Schedule

 

Nonresident/Part-year resident calculation schedule

1

2

3

4

5

6

7

8

.00

.00

.00

.00

.00

.00

.00

.00

TAX DEPT USE ONLY

PAY COR SCTC NRSR HEPTC PLAN

MUST INCLUDE WITHHOLDING

FORMS WITH THIS RETURN

(W-2s, 1099s, Etc.)

–1–

*P40202101W*

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PRIMARY LAST NAME

 

 

 

 

 

 

SOCIAL SECURITY

 

8.Total Taxes Due

 

 

SHOWN ON FORM

 

 

 

 

 

 

NUMBER

 

(line 8 from previous page)

 

 

IT-140

 

 

 

 

 

 

 

 

 

8

9.

Credits from Tax Credit Recap Schedule (see schedule on page 5 ) (now includes the Family Tax Credit)

9

10.

Line 8 minus 9. If line 9 is greater than line 8, enter 0

 

 

10

11.

Overpayment previously refunded or credited (amended return only)

...........................................................

11

 

 

CHECK IF REQUESTING WAIVER/ANNUALIZED

 

12.

Penalty Due from Form IT-210

WORKSHEET ATTACHED

 

If you owe penalty, enter here

12

13.

West Virginia Use Tax Due on out-of-state purchases

 

 

 

 

(See Schedule UT on page 9).

 

CHECK IF NO USE TAX DUE

13

14.

Add lines 10 through 13. This is your total amount due

 

14

 

 

 

Check if withholding from NRSR

 

15.

West Virginia Income Tax Withheld (See instructions)

(Nonresident Sale of Real Estate)

15

16.

Estimated Tax Payments and Payments with Schedule 4868

 

16

17.

Non-Family Adoption Tax Credit if applicable (include Schedule WV NFA-1)

17

18.

Senior Citizen Tax Credit for property tax paid (include Schedule SCTC-A)

18

19.

Homestead Excess Property Tax Credit for property tax paid (include Schedule HEPTC-1)

19

20.

Amount paid with original return (amended return only)

 

20

21.

Payments and Refundable Credits (add lines 15 through 20)

 

21

22.

Balance Due (line 14 minus line 21). If Line 21 is greater than line 14, complete line 23

..... PAY THIS AMOUNT

22

23.

Line 21 minus line 14. This is your overpayment

 

23

24.

Donations of part or all of line 23. Indicate below and enter the sum of columns 24A, 24B, and 24C on Line 24

 

 

24A. WEST VIRGINIA

24B. WEST VIRGINIA DEPARTMENT OF

 

24C. DONEL C. KINNARD MEMORIAL

 

 

CHILDREN’S TRUST FUND

VETERANS ASSISTANCE

 

STATE VETERANS CEMETERY

 

 

 

 

 

 

24

25.

Amount of Overpayment to be credited to your 2022 estimated tax

 

25

26.

Refund due to you (line 23 minus line 24 and line 25)

REFUND

 

 

 

 

 

 

26

.00

.00

.00

.00

.00

.00

.00

.00

.00

.00

.00

.00

.00

.00

.00

.00

.00

.00

.00

Direct Deposit of Refund

CHECKING

SAVINGS

ROUTING NUMBER

ACCOUNT NUMBER

PLEASE REVIEW YOUR ACCOUNT INFORMATION FOR ACCURACY. INCORRECT ACCOUNT INFORMATION MAY RESULT IN A $15.00 RETURNED PAYMENT CHARGE.

I authorize the State Tax Department to discuss my return with my preparer

YES

NO

Under penalty of perjury, I declare that I have examined this return, accompanying schedules, and statements, and to the best of my knowledge and belief, it is true, correct and complete.

Your Signature

 

 

Date

Spouse’s Signature

Date

Telephone Number

 

 

Preparer: Check

 

 

 

 

 

 

 

 

 

HERE if client is

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

requesting that form

 

 

 

 

 

 

 

 

 

NOT be e-filed

 

 

 

 

 

 

 

 

 

Preparer’s EIN

Signature of preparer other than above

Date

Telephone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

Preparer’s Printed Name

 

 

Preparer’s Firm

 

 

 

 

 

FOR REFUND, MAIL TO THIS ADDRESS:

 

FOR BALANCE DUE, MAIL TO THIS ADDRESS:

 

 

 

 

 

WV STATE TAX DEPARTMENT

 

 

WV STATE TAX DEPARTMENT

 

 

 

 

 

 

P.O. BOX 1071

 

 

P.O. BOX 3694

 

 

 

 

 

CHARLESTON, WV 25324-1071

 

 

CHARLESTON, WV 25336-3694

 

 

Payment Options: Returns filed with a balance of tax due may pay through any of the following methods:

Check or Money Order payable to the WV State Tax Department - Enclose check or money order with your return.

Electronic Payment - May be made by visiting mytaxes.wvtax.gov and clicking on “Pay Personal Income Tax”.

Credit Card Payment – May be made by visiting the Treasurer’s website at: epay.wvsto.com/tax

–2–

*P40202102W*

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Schedule

Form IT-140

M W MODIFICATIONS TO ADJUSTED GROSS INCOME 2021

 

Modifications Decreasing Federal Adjusted Gross Income

 

 

Column A (You)

Column B (Spouse)

 

27.

Interest or dividends received on United States or West Virginia obligations, or

 

 

 

 

 

 

 

 

 

allowance for government obligation income, included in federal adjusted gross income

27

 

.00

 

.00

 

 

 

but exempt from state tax

 

 

 

 

 

 

 

 

 

 

28.

Total amount of any benefit (including survivorship annuities) received from certain

28

 

 

 

 

 

 

 

 

federal retirement systems by retired federal law enforcement ocers

 

 

.00

 

.00

 

29.

Total amount of any benefit (including survivorship annuities) received from WV state

29

 

 

 

 

 

 

 

 

or local police, deputy sheris’ or firemen’s retirement system, Excluding PERS –see

 

.00

 

.00

 

 

 

page 22

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

30.

.....................................................................................Military Retirement Modification

 

 

 

 

 

30

 

.00

 

.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

31.

Other Retirement Modification

 

 

Column A (You)

Column B (Spouse)

 

 

 

 

 

 

 

(a) West Virginia Teachers’ and

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Public Employees’ Retirement

 

 

 

.00

 

.00

 

Add lines 31 (a) and (b). If that sum is greater than $2000, enter $2000

 

(b)Federal Retirement Systems

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Title 4 USC §111)

 

 

 

 

 

 

 

.00

 

.00

31

 

.00

 

.00

 

32.

Social Security Benefits

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(a) TOTAL Social Security Benefits.

 

 

 

.00

 

.00

 

You cannot claim this modification if your Federal AGI exceeds

 

(b) Benefits exempt for Federal tax

 

 

 

 

 

 

 

$ 50,000 for SINGLE or MARRIED SEPARATE filers

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$100,000 for MARRIED JOINT filers

 

 

 

purposes

 

 

 

 

 

 

 

 

 

.00

 

.00

 

Multiply 32 (c) by 0.65

 

 

 

 

(c) Benefits taxable for Federal tax

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

purposes (line a minus line b)

 

 

 

 

.00

 

.00

32

 

.00

 

.00

 

33.

Certain assets held by subchapter S Corporation bank

..................................................

 

 

33

 

.00

 

.00

 

34.

Active Duty Military pay for personnel with West Virginia Domicile

 

34

 

.00

 

.00

 

 

 

(See instructions on page 22)

........................................................................................

 

 

 

 

 

 

 

 

 

35.

Active Military Separation (see instructions on page 22)

 

 

35

 

.00

 

.00

 

 

 

Must enclose military orders and discharge papers

 

 

 

 

 

36.

Refunds of state and local income taxes received and reported as income to the IRS ...

36

 

.00

 

.00

 

37.

Contributions to the West Virginia Prepaid Tuition/Savings Plan Trust Funds

 

37

 

.00

 

.00

 

38.

Railroad Retirement Board Income received

..................................................................

 

 

 

38

 

.00

 

.00

 

39.

Long-Term Care Insurance

 

 

 

 

 

 

39

 

.00

 

.00

 

40.

IRC 1341 Repayments

 

 

 

 

 

 

 

40

 

.00

 

.00

 

41.

Autism Modification (instructions on page 22)

 

 

41

 

.00

 

.00

 

42.

ABLE Act

.......................................................................................................................

 

 

 

 

 

 

 

 

 

 

42

 

.00

 

.00

 

43.

PBGC Modification

.....................

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(a) retirement benefits that would have been

 

 

 

.00

 

.00

 

Subtract line 43 (b ) from (a)

 

 

 

 

 

 

paid from your employer-provided plan

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(b) retirement benefits actually received

 

 

 

.00

 

.00

43

 

.00

 

.00

 

 

 

from PBGC

 

 

 

 

 

 

 

 

 

 

 

 

 

44.

Qualified Opportunity Zone business income

 

 

44

 

.00

 

.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(a) Year

of birth

(b)

Year

of

(c) Income not included in

(d) Add lines 27 through 32

 

 

 

 

 

 

 

45.

 

(65 or older)

 

disability

 

lines 33 to 44

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Subtract line 45 column (d) from (c) (If less than zero, enter zero)

 

 

 

 

 

 

 

 

 

 

(NOT TO EXCEED $8000)

 

 

 

 

You

 

 

 

 

 

 

 

 

 

 

.00

 

.00

 

 

.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Spouse

 

 

 

 

 

 

 

 

 

 

.00

 

.00

45

 

 

 

.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*P40202103W*

46. Surviving spouse deduction

46

 

.00

 

.00

 

 

 

Continues on next page

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(instructions on page 23)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Modifications Decreasing Federal Adjusted Gross Income

 

 

 

 

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–3–

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Schedule

Form IT-140

M W MODIFICATIONS TO ADJUSTED GROSS INCOME 2021

Modifications Decreasing Federal Adjusted Gross Income

Column A (You)

Column B (Spouse)

47. Add lines 27 through 46 for each column

47

 

.00

48.Total Subtractions (line 47, Col A plus line 47,Col B) Enter here and on line 3 of FORM IT-140.

48

 

 

 

 

 

 

.00

.00

Modifications Increasing Federal Adjusted Gross Income

 

49.

Interest or dividend income on federal obligations which is exempt from federal tax but subject to state tax

49

50.

Interest or dividend income on state and local bonds other than bonds from West Virginia sources

50

51.

Interest on money borrowed to purchase bonds earning income exempt from West Virginia tax

51

52.

Qualifying 402(e) lump-sum income NOT included in federal adjusted gross income but subject to state tax

52

53.

Other income deducted from federal adjusted gross income but subject to state tax

53

54.

Withdrawals from a WV Prepaid Tuition/Savings Plan Trust Funds NOT used for payment of qualifying expenses

54

55.

ABLE ACT withdrawals not used for qualifying expenses

55

56.TOTAL ADDITIONS (Add lines 49 through 55). Enter here and on Line 2 of Form IT-140

56

.00

.00

.00

.00

.00

.00

.00

.00

*P40202104W*

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–4–

RECAP

W

TAX CREDIT RECAP SCHEDULE

2021

Form IT-140

This form is used by individuals to summarize tax credits that they claim against their personal income tax. In addition to completing this summary form, each tax credit has a schedule or form that is used to determine the amount of credit that can be claimed. Both this sum- mary form and the appropriate credit calculation schedule(s) or form(s) MUST BE ENCLOSED with your return in order to claim a tax credit. Information for all of these tax credits may be obtained by visiting our website at tax.wv.gov or by calling the Taxpayer Services Division at 1-800-982-8297.

Note: If you are claiming the Schedule E credit(s) or the Neighborhood Investment Program Credit you are no longer required to enclose the other state(s) return(s) or the NIPA-2 schedule with your return. You must maintain the other state(s) return(s) or NIPA-2 schedule in your files.

WEST VIRGINIA TAX CREDIT RECAP SCHEDULE

 

 

TAX CREDIT

SCHEDULE

APPLICABLE CREDIT

1.

................................................Credit for Income Tax paid to another state(s)

E

1

 

.00

 

 

 

 

 

 

 

 

 

 

 

** For what states?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

....................................................................Family Tax Credit (see page 39)

FTC-1

2

 

.00

 

 

 

 

 

 

 

 

3.

......................................................General Economic Opportunity Tax Credit

WV EOTC-PIT

3

 

.00

 

 

 

 

 

 

 

 

4.

..........................................WV Environmental Agricultural Equipment Credit

WV AG-1

4

 

.00

 

 

 

 

 

 

 

 

5.

............................................................................WV Military Incentive Credit

J

5

 

.00

 

 

 

 

 

 

 

 

6.

.....................................................Neighborhood Investment Program Credit

NIPA-2

6

 

.00

 

 

 

 

 

 

 

 

7.

........................................Historic Rehabilitated Buildings Investment Credit

RBIC

7

 

.00

 

 

 

 

 

 

 

 

8.

...................Qualified Residential Rehabilitated Buildings Investment Credit

RBIC-A

8

 

.00

 

 

 

 

 

 

 

 

9.

................................................................Apprenticeship Training Tax Credit

WV ATTC-1

9

 

.00

 

 

 

 

 

 

 

 

10.

.............................................................................Alternative-Fuel Tax Credit

AFTC-1

10

 

.00

 

 

 

 

 

 

 

 

11.

..................................................................Conceal Carry Gun Permit Credit

CCGP-1

11

 

.00

 

 

 

 

 

 

 

.........................................................................12. Farm to Food Bank Tax Credit

 

12

 

.00

 

 

 

 

 

 

 

 

13.

.................Downstream Natural Gas Manufacturing Investment Tax Credit

DNG- 2

13

 

.00

 

 

 

 

 

 

 

 

14.

Post Coal Mine Site Business Credit

PCM-2

14

 

.00

 

 

 

 

 

 

 

 

15.

.......................................................................................Natural Gas Liquids

NGL-2

15

 

.00

 

 

 

 

 

 

 

 

16.

Donation or Sale of Vehicle to Qualified Charitable Organizations

DSV-1

16

 

.00

 

 

 

 

 

 

 

 

17.

Small Arms And Ammunition Manufacturers Credit

SAAM-1

17

 

.00

 

 

 

 

 

 

 

18.TOTAL CREDITS — add lines 1 through 17. Enter on Form IT-140, line 9

18

 

.00

 

 

 

 

 

 

 

 

 

 

 

 

 

**You cannot claim credit for taxes paid to KY, MD, PA, OH, or VA unless your source income is other than wages and/or salaries.

*P40202105W*

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–5–

Schedule

FTC-1

Form IT-140 W

FAMILY TAX CREDIT

2021

A Family Tax Credit is available to certain individuals or families that may reduce or eliminate their West Virginia personal income tax. You may be entitled to this credit if you meet certain income limitations and family size. Individuals who file their income tax return with zero exemptions cannot claim the credit. Persons who pay the federal alternative minimum tax are not eligible to claim this credit. In order to determine if you are eligible for this credit, complete the schedule below and attach to Form IT-140.

If this schedule is not enclosed with Form IT-140, the credit will be disallowed.

1.Federal Adjusted Gross Income (enter the amount from line 1 of Form IT-140).................................................

2.Increasing West Virginia modifications (enter the amount from line 2 of Form IT-140).......................................

3.Tax-exempt interest reported on federal tax return (enter the amount shown on Federal Form 1040 that is not already included on line 2 of Form IT-140)..........................................................................................................

4.Add lines 1 through 3. This is your Modified Federal Adjusted Gross Income for the Family Tax Credit............

5.Enter the number of exemptions claimed from Form IT-140, sum of boxes a, b, and c (This is your Family Size for the Family Tax Credit)............................................................................................................................

6.Enter the Family Tax Credit Percentage for your family size AND Modified Federal Adjusted Gross Income level from the tables on page 31. If the exemptions on line 5 are greater than 8, use the table for a family size of 8

7.Enter your income tax due from line 8 of Form IT-140........................................................................................

8.Multiply the amount on line 7 by the percentage shown on line 6

This is your Family Tax Credit. Enter this amount on line 2 of Form IT-140 RECAP .....................................

1

2

3

4

5

6

7

8

.00

.00

.00

.00

.00

.00

Schedule

Form IT-140

DPSCHEDULE OF ADDITIONAL DEPENDENTS 2021

Use this schedule to continue listing dependents. If space is needed for more than 18 dependents, a copy of this form may be obtained from the West Virginia State Tax Department’s website: tax.wv.gov.

First Name

Last Name

Social Security Number

Date of Birth

MM DD YYYY

*P40202110W*

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Schedule

F

Form IT-140 W

STATEMENT OF CLAIMANT

2021

TO REFUND DUE DECEASED TAXPAYER

Attach completed schedule to decedent’s return

NAME OF

DECEDENT

DATE OF

SOCIAL SECURITY

 

DEATH

NUMBER

 

 

 

 

ADDRESS

 

 

(permanent residence or

 

 

domicile at date of death)

 

 

 

 

 

CITY

STATE

ZIP

CODE

 

 

 

 

 

NAME OF

CLAIMANT

SOCIAL SECURITY

NUMBER

ADDRESS

CITY

STATE

ZIP

CODE

 

 

 

 

 

I am filing this statement as (check only one box):

A. Surviving wife or husband, claiming a refund based on a joint return

B. Administrator or executor. Attach a court certificate showing your appointment.

C.Claimant for the estate of the decedent, other than above. Complete the rest of this schedule and attach a copy of the death certificate or proof of death*

ATTACH A LIST TO THIS SCHED-

ULE CONTAINING THE NAME AND ADDRESS OF THE SURVIV- ING SPOUSE AND CHILDREN OF THE DECEDENT.

TO BE COMPLETED ONLY IF BOX C ABOVE IS CHECKED

YES NO

1. Did the decedent leave a will?....................................................................................................................................................................

2(a).Has an administrator or executor been appointed for the estate of the decedent?......................................................................................

2(b) If "NO" will one be appointed?......................................................................................................................................................................

If 2(a) or 2(b) is checked "YES", do not file this form. The administrator or executor should file for the refund.

3.Will you, as the claimant for the estate of the decedent, disburse the refund according to the laws of the state in which the decedent

was domiciled or maintained a permanent residence?.................................................................................................................................

If "NO", payment of this claim will be withheld pending submission of proof of your appointment as administrator or execu- tor or other evidence showing that you are authorized under state law to receive payment.

SIGNATURE AND VERIFICATION

I hereby make request for refund of taxes overpaid by, or on behalf of the decedent and declare under penalties of perjury, that I have examined this claim and to the best of my knowledge and belief, it is true, correct and complete.

Signature of claimant _____________________________________________________ Date _______________________________

*May be the original of an authentic copy of a telegram or letter from the Department of Defense notifying the next of kin of death while in active service, or a death certificate issued by the appropriate officer of the Department of Defense.

*P40202116W*

P

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2

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2

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6

W

–7–

Schedules

H & E

Form IT-140 W

CERTIFICATION FOR PERMANENT AND TOTAL DISABILITY

2021

AND CREDIT FOR INCOME TAX PAID TO ANOTHER STATE

SCHEDULE H CERTIFICATION OF PERMANENT AND TOTAL DISABILITY

TAXPAYERS WHO ARE DISABLED DURING 2021 REGARDLESS OF AGE

If you were certified by a physician as being permanently and totally disabled during the taxable year 2021, OR you were the surviving spouse of an individual who had been certified disabled and DIED DURING 2021, read the instructions to determine if you qualify for the income reducing modification allowed on Schedule M.

If you qualify, you must (1) enter the name of and social security number of the disabled taxpayer in the space provided on this form, (2) have a physician complete the remainder of the certification statement and return it to you, (3) enclose the completed certification with your West Virginia personal income tax return, and (4) complete Schedule M to determine your modification.

A COPY OF YOUR FEDERAL SCHEDULE R (PART II) MAY BE SUBSTITUTED FOR THE WEST VIRGINIA SCHEDULE H.

If you have provided the West Virginia State Tax Department with an approved Certification of Permanent and Total Disability for a prior year AND YOUR DISABILITY STATUS DID NOT CHANGE FOR 2021, you do not have to submit this form with your return. However, you must have a copy of your original disability certification should the Department request verification at a later date.

I Certify under penalties of perjury that the taxpayer named below was permanently and totally disabled on or before December 31, 2021.

 

Name of Disabled Taxpayer

Social Security Number

 

 

 

 

 

 

 

 

Physician’s Name

Physician's FEIN Number

 

 

 

 

 

 

 

 

Physician’s Street Address

 

 

 

 

 

 

 

 

 

City

State

Zip Code

Physicians

 

Date

 

 

 

 

 

 

 

 

 

 

Signature

 

 

MM

DD

YYYY

 

 

 

 

 

 

 

 

 

INSTRUCTIONS TO PHYSICIAN COMPLETING DISABILITY STATEMENT

A PERSON IS PERMANENTLY AND TOTALLY DISABLED WHEN HE OR SHE IS UNABLE TO ENGAGE IN ANY SUBSTANTIAL GAINFUL ACTIVITY BECAUSE OF A MENTAL OR PHYSICAL CONDITION AND THAT DISABILITY HAS LASTED OR CAN BE EXPECTED TO LAST CONTINUOUSLY FOR AT LEAST A YEAR, OR CAN BE EXPECTED TO LEAD TO DEATH. IF, IN YOUR OPINION, THE INDIVIDUAL NAMED ON THIS STATEMENT IS PERMANENTLY AND TOTALLY DISABLED DURING 2021, PLEASE CERTIFY SUCH BY ENTERING YOUR NAME, ADDRESS, SIGNATURE, DATE, AND FEIN NUMBER IN THE SPACES PROVIDED ABOVE AND RETURN TO THE INDIVIDUAL.

ANOTHER STATE

RESIDENCY STATUS

Resident

Nonresident – did not maintain a residence in West Virginia during the taxable year (NO CREDIT IS ALLOWED)

Part-Year Resident – maintained a residence in West Virginia for part of the year; check the box which describes your situation and enter the date of your move:

MM DD YYYY Moved into West Virginia

Moved out of West Virginia, but had West Virginia source income during your nonresident period Moved out of West Virginia and had no West Virginia source income during your nonresident period

SCHEDULE E CREDIT FOR INCOME TAX PAID TO

1.INCOME TAX COMPUTED on your 2021 _________________ return. Do not report Tax Withheld State Abbreviation

2.West Virginia total income tax (line 8 of Form IT-140).........................................................................................

3.Net income derived from above state included in West Virginia total income.....................................................

4.Total West Virginia Income (Residents–Form IT-140, line 4. Part-Year Residents-Schedule A, line 26)............

5.Limitation of Credit (line 2 multiplied by line 3 divided by line 4).........................................................................

6. Alternative West Virginia taxable income Residents – subtract line 3 from line 7, Form IT-140

Part-year residents – subtract line 3 from line 4.............................

7.Alternative West Virginia total income tax (Apply the Tax Rate Schedule to the amount shown on line 6).........

8.Limitation of credit (line 2 minus line 7)...............................................................................................................

9.Maximum credit (line 2 minus the sum of lines 2 through 17 of the Tax Credit Recap Schedule)

10.Total Credit (SMALLEST of lines 1,2, 5, 8, or 9) enter here and on line 1 of the Tax Credit Recap Schedule.

1

2

3

4

5

6

7

8

9

10

.00

.00

.00

.00

.00

.00

.00

.00

.00

.00

A SEPARATE SCHEDULE E MUST BE COMPLETED FOR EACH STATE FOR WHICH CREDIT IS CLAIMED. YOU MUST MAINTAIN A COPY OF THE OTHER STATE TAX RETURN IN YOUR FILES. IN LIEU OF A RETURN YOU MAY MAINTAIN AN INFORMATION STATEMENT AND THE WITHHOLDING STATEMENTS PROVIDED BY THE PARTNERSHIP, LIMITED LIABILITY COMPANY OR S-CORPORATIONS. THIS CREDIT IS NOT ALLOWED IN ANY CASE FOR INCOME TAX IMPOSED BY A CITY, TOWNSHIP, BOROUGH, OR ANY OTHER POLITICAL SUBDIVISION OF A STATE OR ANY OTHER COUNTRY.

Document Specs

Fact Name Description
Filing Deadline The deadline for submitting the 2020 West Virginia Personal Income Tax Return is April 15, 2021.
Governing Law The tax form is governed by West Virginia Code §11-21, which outlines personal income tax regulations.
Form IT-140 Form IT-140 is the official document used for filing personal income tax in West Virginia for the year 2020.
Exemption Amount Each taxpayer is entitled to a total exemption of $2,000 for themselves and their dependents.
Nonresident Filing Nonresidents and part-year residents must use Form WV-8379 to report their income.
Tax Credits Taxpayers can claim various credits, including the Family Tax Credit, which is detailed in the tax credit recap schedule.
Payment Options Payments can be made via check, electronic payment, or credit card through designated state tax websites.
Amended Returns Taxpayers wishing to amend their return must check the appropriate box before the filing deadline.
Use Tax West Virginia imposes a use tax on out-of-state purchases, which must be reported on Schedule UT.
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