IT-140 
    REV 06-22      B    WEST VIRGINIA PERSONAL INCOME TAX RETURN                                                                                            2022
SOCIAL                                Deceased                                        **SPOUSE’S                                                    Deceased
SECURITY                                                                   SOCIAL SECURITY 
NUMBER                                Date of Death*                                  NUMBER                                                        Date of Death*
                                                                                                          YOUR 
LAST NAME                                                                  SUFFIX                         FIRST                                                   MI
                                                                                                          NAME
                                                                                                  SPOUSE’S 
SPOUSE’S                                                                   SUFFIX                         FIRST                                                   MI
LAST NAME                                                                                                 NAME
FIRST LINE                                                                            SECOND LINE 
OF ADDRESS                                                                            OF ADDRESS

    CITY                                                                   STATE                  ZIP CODE
                                                                                                                                                    EXTENDED 
TELEPHONE                             EMAIL                                                                                                         DUE DATE
NUMBER                                                                                                                                              MM/DD/YYYY
            * ONLY INLCLUDE A DECEASED TAXPAYER AND THEIR DATE OF DEATH IF IT OCCURRED IN THIS TAX YEAR. FOR THE NEXT TWO YEARS, PLEASE LIST THEM BELOW ON THE SURVIVING SPOUSE EXPEMPTION. 
    AMENDED  RETURN     NONRESIDENT SPECIAL                                NONRESIDENT/PART YEAR RESIDENT       FORM WV-8379 FI LED AS AN INJURED SPOUSE

FILING STATUS           1 SINGLE      2 HEAD OF                            3 MARRIED,   4 MARRIED, FILING SEPARATE                                                5 WIDOW(ER) WITH 
    (CHECK ONE)                       HOUSEHOLD                            FILING JOINT          **Enter spouse’s SS# and name in the boxes above                 DEPENDENT CHILD
EXEMPTIONS
(a) YOURSELF            To claim an exemption for yourself, enter 1. If someone can claim you as a dependent, leave box (a) blank.)                               (a)

(b) SPOUSE              To claim an exemption for your spouse, enter 1. They may not be claimed as an exemption by anyone else.                                   (b)

(c) DEPENDENTS          List your dependents. If over four dependents, continue on Schedule DP on page 11. Enter total number of dependents                       (c) 
              Dependent First name                                         Dependent Last name                  Social Security Number                      Date of Birth (MM DD YYYY)

(d) SURVIVING SPOUSE    (See page 21) Decedents SSN                                     Year Spouse Died:
                                                                                                                                                                  (d)
(e) Total Exemptions    (add boxes a, b, c, and d). Enter here and on line 6 below. If box e is zero, enter $500 on line 6 below.                                 (e) 

1.  Federal Adjusted Gross Income or income to claim senior citizen tax credit from Schedule SCTC-A                                               1                       .00

2.  Additions to income (line 58 of Schedule M).............................................................................................      2                       .00

3.  Subtractions from income (line 49 of Schedule M)....................................................................................          3                       .00

4.  West Virginia Adjusted Gross Income (line 1 plus line 2 minus line 3)......................................................                   4                       .00

5.  Low-Income Earned Income Exclusion (see worksheet on page 25)........................................................                         5                       .00

6.  Total Exemptions as shown above on Exemption Box (e) ________ x $2,000 ........................................                               6                       .00

7.  West Virginia Taxable Income (line 4 minus lines 5 & 6) IF LESS THAN ZERO, ENTER ZERO ............                                            7                       .00

8.  Income Tax Due (Check One)  ................................................................................................................. 8                       .00
         Tax Table      Rate Schedule Nonresident/Part-year resident 
                                      calculation schedule
         TAX DEPT USE ONLY            MUST INCLUDE WITHHOLDING 
    PAY 
    PLAN    COR    SCTC NRSR HEPTC    FORMS WITH THIS RETURN
                                                                                                          *P40202201A*
                                               (W-2s, 1099s, Etc.)                                              P40202201A
                                                                           –1–

 PRIMARY                                                     SOCIAL SECURITY                                      8.Total Taxes Due 
 LAST NAME                                                   NUMBER                                               (line 8 from previous page)                .00
                                                                                                                                               8

 9.  Credits from Tax Credit Recap Schedule (see schedule on page 5 ) ............................................................             9             .00

 10. Line 8 minus 9. If line 9 is greater than line 8, enter 0                                                                                 10            .00

 11. Overpayment previously refunded or credited (amended return only) ...........................................................             11            .00
                                                CHECK IF REQUESTING WAIVER/ANNUALIZED 
 12. Penalty Due from Form IT-210               WORKSHEET ATTACHED                                              If you owe penalty, enter here 12            .00
                                                                                             
 13. West Virginia Use Tax Due on out-of-state purchases 
 (See Schedule UT on page 41).                                                                  CHECK IF NO USE TAX DUE ...............        13            .00

 14. Add lines 10 through 13. This is your total amount due..................................................................................  14            .00

                                                                                                Check if withholding from NRSR  
 15. West Virginia Income Tax Withheld (See instructions page 22)                               (Nonresident Sale of Real Estate)              15            .00

 16. Estimated Tax Payments and Payments with Schedule 4868 .......................................................................            16            .00

 17. Non-Family Adoption Tax Credit if applicable (include Schedule WV NFA-1) ................................................                 17            .00

 18. Senior Citizen Tax Credit for property tax paid (include Schedule SCTC-A) ..................................................              18            .00

 19. Homestead Excess Property Tax Credit for property tax paid (include Schedule HEPTC-1 and Class II receipt)                                19            .00

 20. Amount paid with original return (amended return only) ................................................................................   20            .00

 21. Payments and Refundable Credits (add lines 15 through 20) .......................................................................         21            .00

 22. Balance Due (line 14  minus line 21). If Line 21 is greater than line 14, complete line 23 .....     PAY THIS AMOUNT                      22            .00

 23. Line 21 minus line 14. This is your overpayment ......................................................................................... 23            .00
 24. Indicate donations from line 23. Enter below and enter the sum of columns 24A, 24B, and 24C on Line 24
       24A.                                       24B.                                                24C.
 CHILDREN’S TRUST                          WV DEPT. OF VETERANS                              STATE VETERANS 
       FUND                                       ASSISTANCE                                    CEMETERY                                       24            .00

 25. Amount of Overpayment to be credited to your 2023 estimated tax...............................................................            25            .00

 26. Refund due to you (line 23 minus line 24 and line 25).............................................................. REFUND                26            .00
 Direct Deposit             
 of Refund                  CHECKING                                SAVINGS                     ROUTING NUMBER                                 ACCOUNT NUMBER
 PLEASE REVIEW YOUR ACCOUNT INFORMATION FOR ACCURACY. INCORRECT ACCOUNT INFORMATION MAY RESULT IN A $15.00 RETURNED PAYMENT CHARGE.
 I authorize the Tax Division 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.

Your Signature                                    Date                       Spouse’s Signature                          Date                     Telephone Number
 Preparer: Check 
 HERE if client is 
 requesting NOT 
 to e file
                         Preparer’s EIN           Signature of preparer other than above                                 Date                     Telephone Number

 Preparer’s Printed Name                          Preparer’s Firm
       FOR REFUND, MAIL TO THIS ADDRESS:                     FOR BALANCE DUE, MAIL TO THIS ADDRESS:
                   WV TAX DIVISION                                           WV TAX DIVISION
                         P.O. BOX 1071                                       P.O. BOX 3694
               CHARLESTON, WV 25324-1071                             CHARLESTON, WV 25336-3694
   Payment Options: Returns  fi         led with a balance of tax due may pay through any of the following methods:
    •    Check or Money Order payable to the WV Tax Division - Enclose check or money order with your return. 
    •    Electronic Payment - May be made by visiting mytaxes.wvtax.gov and clicking on “Pay Personal Income Tax”.
    •    Credit Card Payment – May be made by visiting the Treasurer’s website at: epay.wvsto.com/tax                    *P40202202A*
                                                                                                                         P40202202A
                                                                                            –2–