Schedule                        NONRESIDENTS/PART-YEAR RESIDENTS
           A
    Form IT-140    W                                  SCHEDULE OF INCOME
                                                                                                                                                      2022
                                 PART-YEAR RESIDENTS:                                  FROM:                                                    TO:
                       Enter period of West Virginia residency                         MM/DD/YYYY                                           MM/DD/YYYY
  (To Be Completed By Nonresidents and Part-Year Residents Only)                       COLUMN A:                         COLUMN B:                    COLUMN C: 
                       INCOME                                                       AMOUNT FROM  FEDERAL RETURN ALL INCOME DURING PERIOD        WV SOURCE INCOME DURING 
                                                                                                                OF WV RESIDENCY                 NONRESIDENT PERIOD

1. Wages, salaries, tips (withholding documents) ..........                         1                       .00                             .00                 .00

2. Interest ....................................................................... 2                       .00                             .00                 .00

3. Dividends ...................................................................    3                       .00                             .00                 .00

4.  IRAs, pensions and annuities .....................................              4                       .00                             .00                 .00
5. Total taxable Social Security and Railroad Retirement
    bene fits (see line 32 and 38 of Schedule M) ................                    5                       .00                             .00
6. Refunds of state and local income tax
    (see line 36 of Schedule M) ........................................            6                       .00                             .00

7. Alimony received .......................................................         7                       .00                             .00

8. Business pro  tfi(or loss) ..............................................         8                       .00                             .00                 .00

9. Capital gains (or losses) ............................................           9                       .00                             .00                 .00

10. Supplemental gains (or losses) .................................. 10                                    .00                             .00                 .00

11. Farm income (or loss) ................................................ 11                               .00                             .00                 .00

12. Unemployment compensation insurance ..................                          12                      .00                             .00                 .00
13. Other income from federal return (identify source)
                                                                                    13                      .00                             .00                 .00

14. Total income (add lines 1 through 13) ........................ 14                                       .00                             .00                 .00
ADJUSTMENTS

15. Educator expenses ...................................................           15                      .00                             .00                 .00

16. IRA deduction ............................................................      16                      .00                             .00                 .00

17. Self-employment tax deduction .................................                 17                      .00                             .00                 .00

18. Self Employed SEP, SIMPLE and quali fied plans ...... 18                                                 .00                             .00                 .00

19. Self-employment health insurance deduction ............ 19                                              .00                             .00                 .00

20. Penalty for early withdrawal of savings ...................... 20                                       .00                             .00                 .00

21. Other adjustments (See instructions page 28) ...........                        21                      .00                             .00                 .00

22. Total adjustments (add lines 15 through 21) .............. 22                                           .00                             .00                 .00
23. Adjusted gross income
    (subtract line 22 from line 14 in each column) ............ 23                                          .00                             .00                 .00
                                                                                    24. West Virginia income
                                                                                       (line 23, Column B plus column C)                    24                  .00
                                                                                    25. Income subject to West Virginia Tax but exempt 
                                                                                       from federal tax.................................... 25                  .00
   *P40202207W*                                                                     26. Total West Virginia income (line 24 plus line 25). 
    P40202207W                                                                         Enter here and on line 2 on the next page            26                  .00
                                                                                       –9–

  Schedule 
           A     W                      NONRESIDENTS/PART-YEAR RESIDENTS
  Form IT-140                                       SCHEDULE OF INCOME
                                                                                                                                                              2022
                                                    SCHEDULE A (CONTINUED)

PART I: NONRESIDENT/PART-YEAR RESIDENT TAX CALCULATION

1.  Tentative Tax (apply the appropriate tax rate schedule on page 34 to the amount shown on line 7, Form IT-140).....                                      1       .00

2.  West Virginia Income (line 26, Schedule A)............................................................................................................. 2       .00

3.  Federal Adjusted Gross Income (line 1, Form IT-140)..............................................................................................       3       .00
4.  Tax (divide line 2 by line 3, round to 4 decimal places and multiply the result by line 1). 
Enter here and on line 8, Form IT-140 .................................................................................................................     4       .00
PART II: SPECIAL NONRESIDENT INCOME FOR RESIDENTS OF RECIPROCAL STATES 
         AND CERTAIN ACTIVE MILITARY MEMBERS
ELIGIBILITY:  Complete this section ONLY if ALL THREE of the following statements were true for 2022.
• You were EITHER a resident of Kentucky, Maryland, Ohio, Pennsylvania or Virginia 
  OR a member of the military assigned to active duty in West Virginia whose domicile is outside West Virginia
• Your only West Virginia source income was from wages and salaries.
• West Virginia income tax was withheld from such wages and salaries by your employer(s).
If you were a non-military, domiciliary resident of Pennsylvania or Virginia and spent more than 183 days in West Virginia, you are also considered a 
resident of West Virginia and must  file Form IT-140 as a resident of West Virginia.
NOTE: If you were a resident of any state other than Kentucky, Ohio, Maryland, Pennsylvania, or Virginia, you are ineligible to complete Part 
II. You must check the box Filing as Nonresident or Filing as a Part-Year Resident and Complete Schedule A and Part I to report any income 
from West Virginia sources.
I declare that I was not a resident of West Virginia at any time during 2022, I was a resident of the state shown OR was in West Virginia 
pursuant to active duty military orders, my only income from sources within West Virginia was from wages and salaries, and such wages 
and salaries were subject to income taxation by my state of residence.
                                             YOUR STATE OF RESIDENCE (Check one):
   1 Commonwealth of Kentucky            4 Commonwealth of Pennsylvania   Number of days spent in West Virginia

   2 State of Maryland                   5 Commonwealth of Virginia       Number of days spent in West Virginia

   3  State of Ohio                      6 Active Military, stationed in West Virginia but not domiciled here (Must enclose military order and DD2058)
                                                                                                              (A)                                             (B)
                                                                                                              Primary Taxpayer's Social                       Spouse's Social Security 
                                                                                                              Security Number                                 Number

5.  Enter your total West Virginia Income from wages and salaries in the appropriate column                 5                 .00                                   .00
6.  Enter total amount of West Virginia Income Tax withheld from your wages and 
salaries paid by your employer in 2022 .................................................................... 6                 .00                                   .00

7.  Line 6, column A plus line 6 column B. Report this amount on line 15 of Form IT-140 .........................................                           7       .00

                                                                                                              *P40202208W*
                                                                                                              P40202208W
                                                                     –10–