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4 4
5 K-1C FROM SP Schedule of WV Partner/Shareholder/Member/Beneficiary Information 5
6 6
REV 07-23 for Corporations Subject to Corporate Income Tax 2023
7 TAXABLE YEAR OF ORGANIZATION 7
8 8
BEGINNING ENDING
9 MM/DD/YYYY MM/DD/YYYY 9
10 ORGANIZATION NAME (please type or print) NAME OF PARTNER/SHAREHOLDER/MEMBER/BENEFICIARY 10
11 11
12 12
13 STREET or POST OFFICE BOX STREET or POST OFFICE BOX 13
14 14
15 15
16 CITY STATE ZIP CITY STATE ZIP 16
17 17
18 18
19 WV IDENTIFICATION NUMBER FEIN FEIN WV IDENTIFICATION NUMBER 19
20 20
21 21
22 CHECK WITHHOLDING 22
23 ONE: S Corporation 1. Income subject to withholding for nonresident as reported on 23
24 organization’s S Corporation, Partnership or Fiduciary Return $ .00 24
25 Limited Liability Company 25
26 2. Amount of West Virginia tax withheld (see instructions) $ .00 26
27 27
28 Partnership Fiduciary PERCENTAGE OF OWNERSHIP % 28
29 29
DISTRIBUTIVE SHARE
30 INCOME 30
31 31
32 1. Distributive pro rata share of income allocable to West Virginia........................................... 1 .00 32
33 ADDITIONS 33
34 34
2. Interest or dividend income on federal obligations which is exempt from federal tax but
35 subject to state tax............................................................................................................ 2 .00 35
36 36
3. Interest or dividend income on state and local bonds other than bonds from West Virginia
37 sources.............................................................................................................................. 3 .00 37
38 38
4. Interest on money borrowed to purchase bonds earning income exempt from West
39 Virginia tax......................................................................................................................... 4 .00 39
40 40
5. Any amount not included in federal income that was an eligible contribution for the
41 Neighborhood Investment Program Tax Credit................................................................. 5 .00 41
42 42
43 6. Other Income deducted from federal adjusted gross income but subject to state tax...... 6 .00 43
44 44
45 7. Federal depreciation/amortization for WV water/air pollution control facilities ................... 7 .00 45
46 46
47 8. Unrelated business taxable income of a corporation exempt from federal tax................... 8 .00 47
48 48
49 9. Add back expenses for certain REIT’s and RIC’s.............................................................. 9 .00 49
50 SUBTRACTIONS 50
51 51
10. Interest or dividends received on United States or West Virginia obligations included in
52 federal adjusted gross income but exempt from state tax................................................. 10 .00 52
53 53
54 11. Refunds of state and local income taxes received and reported as income to the IRS.... 11 .00 54
55 55
12. Other income included into federal adjusted gross income but excluded from state
56 income tax......................................................................................................................... 12 .00 56
57 57
58 13. Salary expense not allowed on federal return due to claiming the federal jobs credit........ 13 .00 58
59 14. Cost of WV water/air pollution 59
60 control facilities .................... 14 .00 60
61 15.Allowance for governmental 61
62 obligations/obligations secured 15 .00 62
63 *B30022301W* by residential property ........... 63
B30022301W
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