Schedule 
  DP        B
Form IT-140         SCHEDULE OF ADDITIONAL  DEPENDENTS      2022
Use this schedule to continue listing dependents. 
If space is needed for more than 25 dependents, a copy of this form may be obtained from the West Virginia Tax Division’s 
website: tax.wv.gov.
            First Name                            Last Name Social Security Number Date of Birth 
                                                                                   MM DD YYYY

                                                            *P40202211A*
                                                            P40202211A
                                                  –11–