PTE-100                                         WEST VIRGINIA TAX RETURN 
    REV 07/2022     W      S CORPORATION & PARTNERSHIP (PASS-THROUGH ENTITY)
                                                                                                                                                                        2022
TAX PERIOD BEGINNING                                    ENDING                                                                                            EXTENDED 
               MM/DD/YYYY                           MM/DD/YYYY                                                                                            DUE DATE
                                                                                                                                                          MM/DD/YYYY
ENTITY NAME                                                                                                                     FEIN                            WV ACCOUNT NUMBER

MAILING ADDRESS                                                                                                                 HAS THE PARTNERSHIP ELECTED OUT OF THE CENTRALIZED AUDIT REGIME 
                                                                                                                                UNDER IRC SECTION 6221(b)?
                                                                                                                                                   IF NO, PROVIDE A DESIGNATION OF THE STATE 
                                                                                                                                 Yes NO            PARTNERSHIP REPRESENTATIVE (OR THE FEDERAL 
CITY                                        STATE   ZIP                                                                                            PARTNERSHIP REPRESENTATIVE)
                                                                                                                                REPRESENTATIVE FIRST NAME    LAST NAME

STATE OF DOMICILE          NAICS
                                                    CHANGE OF                                                                   REPRESENTATIVE TIN           REPRESENTATIVE US PHONE
                                                    ADDRESS
CONTACT FIRST NAME         CONTACT LAST NAME
                                                                                                                                REPRESENTATIVE US ADDRESS

CONTACT PHONE              CONTACT EMAIL 

                                                                                                                     1) ENTITY  S-CORPORATION             PARTNERSHIP
CHECK ALL APPLICABLE BOXES                                                                                                 TYPE (INCLUDE 1120S)           (INCLUDE 1065)

2) RETURN TYPE      ANNUAL                  INITIAL                                                                  FINAL      AMENDED                   OTHER

                    52/53 WEEK FILER DAY OF WEEK ENDING                                                                                                   FISCAL

3) IF FINAL/SHORT/  CEASED OPERATIONS IN WV         CHANGE OF OWNERSHIP                                                         CHANGE OF FILING STATUS         MERGER
    INITIAL RETURN

                    SUCCESSOR  FEIN OF PREDECESSOR:                                                                             TECHNICAL TERMINATIONS          OTHER

4) ACTIVITY DESCRIPTION:                    WHOLLY WV ACTIVITY                                                                  MULTISTATE ACTIVITY
5) REPORTABLE ENTITIES (ALL ENTITIES MUST BE INCLUDED ON SCHEDULE D):
                    A. ANY PTE YOU ARE A PARTNER, MEMBER, OR SHAREHOLDER DOING BUSINESS IN WV

                    B. ANY ENTITY YOU OWN 80% OF VOTING STOCK                                                                   D. ANY DISREGARDED ENTITY, INCLUDING QSUBS

                    C. ANY ENTITY THAT OWNED MORE THAN 80% OF YOUR STOCK                                                        E. ANY CONTROLLED FOREIGN CORPORATION
                                                                                                                                     (A) INCOME                         (B) WITHHOLDING

6)  WV DISTRIBUTIVE INCOME OF RESIDENTS...............................................................                                                    .00
7)  WV DISTRIBUTIVE INCOME OF NONRESIDENTS FILING ON A NONRESIDENT 
    COMPOSITE TAX RETURN AND WITHHOLDING DUE
    (SCHEDULE SP, COLUMN F).......................................................................................                                        .00                                .00
8)  WV DISTRIBUTIVE INCOME OF NONRESIDENTS SUBJECT  TO WV 
    WITHHOLDING  THAT ARE NOT FILING A NONRESIDENT COMPOSITE  TAX 
    RETURN AND WITHHOLDING DUE (SCHEDULE SP, COLUMN G) ..............                                                                                     .00                                .00
9)  WV DISTRIBUTIVE INCOME OF NONRESIDENTS WHO HAVE ATTESTED ON A 
    NRW-4 THAT THEY WILL FILE AND PAY WV INCOME TAX DIRECTLY OR ARE 
    TAX EXEMPT ENTITIES ............................................................................................                                      .00
10) TOTAL WV INCOME 
    (SUM OF LINE 6 THROUGH 9, MUST MATCH SCHEDULE A, LINE 13)...................                                                                          .00
11) TOTAL WV WITHHOLDING DUE (LINE 7 PLUS LINE 8)..................................
                                                                                                                                                                                             .00

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         NAME                                                                                                                 FEIN

11. Total WV withholding due (from previous page).........................................................                 11                         .00

12. Prior year carryforward credit...................................................................  12                             .00

13. Estimated and extension payments.........................................................          13                             .00
14. Total Withholding credits (see instructions) ............................................
         CHECK HERE IF WITHHOLDING IS FROM NRSR (NONRESIDENT SALE OF REAL ESTATE)                      14                             .00

15. Payments (add lines 12 through 14; must match total on Schedule C)                                                     15                         .00

16. Overpayment previously refunded or credited (amended return only) ......................                               16                         .00

17. TOTAL PAYMENTS (subtract line 16 from line 15)...................................................                      17                         .00
18. Tax Due – If line 17 is smaller than line 11, enter amount owed. If line 17 is larger 
    than line 11 skip to Line 22 ........................................................................................  18                         .00

19. Interest for late payment............................................................................................. 19                         .00

20. Additions to tax for late  filing and/or late payment.......................................................            20                         .00

21. Total Due with this return (add lines 18 through 20)  ................................................                 21                           .00

22. Overpayment (Line 17 less line 11).........................................................        22                             .00

23. Amount of line 22 to be credited to next year’s tax ................................               23                             .00

24. Amount to be refunded (line 22 minus line 23)........................................              24                             .00

Direct Deposit                   CHECKING                       SAVINGS
of Refund
                                                                                                             ROUTING NUMBER       ACCOUNT NUMBER
         PLEASE REVIEW YOUR ACCOUNT INFORMATION FOR ACCURACY. INCORRECT ACCOUNT INFORMATION MAY RESULT IN A $15.00 RETURNED PAYMENT CHARGE.
                                                          PLEASE SEE PAGE 3 OF INSTRUCTIONS FOR PAYMENT OPTIONS.

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.

Signature of O  fficer/Partner or Member                            Print name of O  fficer/Partner or Member                         Date

Title                                                                                                  Email                      Business Telephone #

Signature of paid preparer                                        Print name of Preparer                                          Date

Firm’s name and address                                                                                Preparer’s Email           Preparer’s Telephone #

MAKE CHECKS PAYABLE TO AND MAIL TO:  WEST VIRGINIA TAX DIVISION
                                                                               TAX ACCOUNT ADMINISTRATION  
                                                                               PO BOX 11751 
                                                                               CHARLESTON WV 25339-1751
         
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