WV IT-104

                                                                                      Employee's Withholding 

                                                                                       Exemption Certificate

Complete this form and present it to your employer to avoid any delay in adjusting the amount of state income tax to 
be withheld from your wages. 

If  you  do  not  complete  this  form,  the  amount  of  tax  that  is  now  being  withheld  from  your  pay  may  not 
be sufficient to cover the total amount of tax due the state when filing your personal income tax return after the close of 
the year. You may be subject to a penalty on tax owed the state. 

Individuals are permitted a maximum of one exemption for themselves, plus an additional exemption for their spouse 
and any dependent other than their spouse that they expect to claim on their tax return. 

If  you  are  married  and  both  you  and  your  spouse  work  and  you  file  a  joint  income  tax  return,  or  if 
you are  working  two  or  more  jobs,  the  revised  withholding  tables  should  result  in  a  more  accurate  amount 
of tax being withheld. 

If you are Single, Head of Household, or Married and your spouse does not work, and you are receiving wages from 
only one job, and you wish to have your tax withheld at a lower rate, you must check the box on line 5. 

When requesting withholding from pension and annuity payments you must present this completed form to the payor. 
Enter the amount you want withheld on line 6. 

If  you  determine  the  amount  of  tax  being  withheld  is  insufficient,  you  may  reduce  the  number  of 
exemptions you are  claiming  or  request  additional  taxes  be  withheld  from  each  payroll  period.  Enter  the  additional 
amount  you want to have withheld on line 6. 

Employees  who  reside  in  Kentucky,  Maryland,  Ohio,  Pennsylvania,  Virginia  or  who  are  a  Military  Spouse 
exempt from income tax on wages, see page 2.  

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WV IT-104      
Rev. 03/2023   WEST VIRGINIA EMPLOYEE’S WITHHOLDING EXEMPTION CERTIFICATE

Name                                                           Social Security Number 

Address 

City                                          State                  Zip Code 
1.   If SINGLE, and you claim an exemption, enter “1”, if you do not, enter “0 .......................................... 
2.   If MARRIED, one exemption each for husband and wife if not claimed on another certificate.
     (a)       If you claim both of these exemptions, enter “2”
     (b)       If you claim one of these exemptions, enter “1”      ........................................ 
     (c)       If you claim neither of these exemptions, enter “0”
3.   If you claim exemptions for one or more dependents, enter the number of such exemptions. ........... 
4.   Add the number of exemptions which you have claimed above and enter the total ............................ 
5.   If  you  are  Single,  Head  of  Household,  or  Married  and  your  spouse  does  not  work,  and  you  are
     receiving wages from only one job, and you wish to have your tax withheld at a lower rate, check here
6.   Additional withholding per pay period under agreement with employer, enter amount here .............. $ 
I certify, under penalties provided by law, that the number of exemptions claimed in this certificate is not in excess of those to which I am entitled. 

Date                         Signature
                                                                                         NONRESIDENTS - SEE REVERSE SIDE
Page 1 of 2 | Employee’s Withholding Exemption Certificate                             March 2023 | West Virginia Tax Division                           

                                                                                                     WV IT-104NR 

                                                                                 Certificate of Nonresidence

If you are a resident of Kentucky, Maryland, Ohio, Pennsylvania or Virginia and your only source of income from West 
Virginia is  wages or salaries, you are exempt from West Virginia Personal Income Tax Withholding. Upon receipt of this 
form, properly completed, your employer is authorized to discontinue the withholding of West Virginia Income Tax from 
your wages or salaries earned in West Virginia.

If you are a military spouse and (a) your spouse is a member of the armed forces present in West Virginia in compliance 
with  military  orders;  (b)  you  are  present  in  West  Virginia  solely  to  be  with  your  spouse;  and  (c)  you  maintain  your 
domicile in another State and you are claiming exemption under the Servicemember Civil Relief Act, enter your state of 
domicile (legal residence) on the following statement and attach a copy of your spousal military identification card.

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      WV/IT-104NR 
      Rev.03/2023        WEST VIRGINIA CERTIFICATE OF NONRESIDENCE              

This form is to be completed by employees who reside in Kentucky, Maryland, Ohio, Pennsylvania, Virginia or by an employee who 
is a Military Spouse exempt from income tax on wages. 
I  certify  that  I  am  a  legal  resident  of  the  state  of  ____________ and am not subject to West Virginia withholding because
l meet the  requirements  set  forth  under  the  Servicemembers  Civil  Relief  Act,  as  amended  by  the  Military  Spouses
Residency  Relief  Act.
Name                                                   Social Security Number 

Address 

City                                           State                             Zip Code 

I hereby certify, under penalties provided by law, that I am not a resident of West Virginia, that I reside in the State of ____________ 
and  live  at  the  address  shown  on  this  certificate,  and  request  is  hereby  made  to  my  employer  to  NOT  withhold  West Virginia 
income tax from wages paid to me. If at any time hereafter I become a resident of West Virginia, or otherwise lose my status of 
being exempt from West Virginia withholding taxes, I will properly notify my employer of such fact within ten (10) days from the 
date of change so that my employer may then withhold West Virginia income tax from my wages. 
I certify that the above statements are true, correct, and complete. 

Date                     Signature

Page  2of 2 | Employee’s Withholding Exemption Certificate                                March 2023 | West Virginia Tax Division