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Schedule of WV Partner/Shareholder/Member/Bene fi ciary Information
K-1C FROM SP
REV 07-22 for Corporations Subject to Corporate Income Tax 2022
TAXABLE YEAR OF ORGANIZATION
BEGINNING ENDING
MM/DD/YYYY MM/DD/YYYY
ORGANIZATION NAME (please type or print) NAME OF PARTNER/SHAREHOLDER/MEMBER/BENEFICIARY
STREET or POST OFFICE BOX STREET or POST OFFICE BOX
CITY STATE ZIP CITY STATE ZIP
WV IDENTIFICATION NUMBER FEIN FEIN WV IDENTIFICATION NUMBER
CHECK WITHHOLDING
ONE: S Corporation 1. Income subject to withholding for nonresident as reported on
organization’s S Corporation, Partnership or Fiduciary Return $ .00
Limited Liability Company
2. Amount of West Virginia tax withheld (see instructions) $ .00
Partnership Fiduciary PERCENTAGE OF OWNERSHIP %
DISTRIBUTIVE SHARE
INCOME
1. Distributive pro rata share of income allocable to West Virginia........................................... 1 .00
ADDITIONS
2. Interest or dividend income on federal obligations which is exempt from federal tax but
subject to state tax............................................................................................................ 2 .00
3. Interest or dividend income on state and local bonds other than bonds from West Virginia
sources.............................................................................................................................. 3 .00
4. Interest on money borrowed to purchase bonds earning income exempt from West
Virginia tax......................................................................................................................... 4 .00
5. Any amount not included in federal income that was an eligible contribution for the
Neighborhood Investment Program Tax Credit................................................................. 5 .00
6. Other Income deducted from federal adjusted gross income but subject to state tax...... 6 .00
7. Federal depreciation/amortization for WV water/air pollution control facilities ................... 7 .00
8. Unrelated business taxable income of a corporation exempt from federal tax................... 8 .00
9. Add back expenses for certain REIT’s and RIC’s.............................................................. 9 .00
SUBTRACTIONS
10. Interest or dividends received on United States or West Virginia obligations included in
federal adjusted gross income but exempt from state tax................................................. 10 .00
11. Refunds of state and local income taxes received and reported as income to the IRS.... 11 .00
12. Other income included into federal adjusted gross income but excluded from state
income tax......................................................................................................................... 12 .00
13. Salary expense not allowed on federal return due to claiming the federal jobs credit........ 13 .00
14. Cost of WV water/air pollution
control facilities .................... 14 .00
15.Allowance for governmental
obligations/obligations secured 15 .00
*B30022201W* by residential property ...........
B30022201W
