WEST VIRGINIA  
    REVCIT-1208/23    W                CORPORATION NET INCOME TAX RETURN                                                2023
                                                                                                             EXTENDED 
    TAX PERIOD BEGINNING                                                ENDING                               DUE DATE
                     MM/DD/YYYY                                        MM/DD/YYYY                            MM/DD/YYYY

 CORPORATION NAME                                                                   FEIN

 MAILING ADDRESS                                                                    WV CORPORATION INCOME TAX ACCOUNT NUMBER

 CITY                                        STATE ZIP
                                                                                     CHANGE OF ADDRESS

 STATE OF DOMICILE              NAICS                     CONTACT NAME                                       CONTACT PHONE
                                 
                                                                       1) ENTITY 
 CHECK ALL APPLICABLE BOXES                                             TYPE        CORPORATION          NONPROFIT

 2) RETURN TYPE      ANNUAL                         INITIAL             FINAL       AMENDED              RAR (Form 870 or 4549-A/B must be provided)

                     52/53 WEEK FILER  DAY OF WEEK ENDING                                                FISCAL         OTHER

 3) IF FINAL/SHORT/  CEASED OPERATIONS IN WV        CHANGE OF OWNERSHIP             CHANGE OF FILING STATUS     MERGER
    INITIAL RETURN
                     SUCCESSOR  FEIN OF PREDECESSOR                                 TECHNICAL TERMINATIONS      OTHER

 4) FILING METHOD    SEPARATE ENTITY                CHECK HERE IF SEPARATE BUT PART OF FEDERAL CONSOLIDATED. ENTER FEIN:

                     COMBINED                       SEPARATE COMBINED
                     (UB-CR)
                                                    GROUP COMBINED  SURETY FEIN:

                                                    WORLDWIDE ELECTION

 5) IF SEPARATE, INDICATE ACTIVITY                  WHOLLY WV ACTIVITY (SCHEDULE 1) MULTISTATE ACTIVITY (SCHEDULE 2) 
                                                    (WV ACTIVITY ONLY) 
 6) REPORTABLE ENTITIES (ALL ENTITIES MUST BE INCLUDED ON SCHEDULE D)
                     A. ANY PTE YOU ARE A PARTNER, MEMBER, OR SHAREHOLDER DOING BUSINESS IN WV

                     B. ANY ENTITY YOU OWN 80% OF VOTING STOCK                      D. ANY DISREGARDED ENTITY

                     C. ANY ENTITY THAT OWNED MORE THAN 80% OF YOUR STOCK           E. ANY CONTROLLED FOREIGN CORPORATION

 7) CURRENTLY UNDER AUDIT BY THE IRS?  NO           YES
                                                    YEARS UNDER AUDIT:

 8) TYPE OF FEDERAL RETURN INCLUDED WITH THIS RETURN                    1120        PROFORMA 1120        990            990T

                                                                                        *B30202301W*
                                                                                              B30202301W

      NAME                                                                                                            FEIN

9. Adjusted Corporate Net Income Tax from Schedule 1,Schedule 2, or UB-CR .....                                    9                    .00

10. Prior year carryforward credit...................................................................      10                 .00

11. Estimated and extension payments.........................................................              11                 .00
12. Withholding must match the withholding statements unless withholding
    is from NRSR.......................................................................................... 12                 .00
      CHECK HERE IF WITHHOLDING IS FROM NRSR (NONRESIDENT SALE OF REAL ESTATE)

13. Build WV Property Value Adjustment Tax Credit .....................................                    13                 .00

14. Payments (add lines 10 through 13;) .......................................................................... 14                           .00

15. Overpayment previously refunded or credited (amended return only)........................                      15                           .00

16. TOTAL PAYMENTS (subtract line 15 from line 14) ....................................................            16                           .00

17. If line 16 is larger than line 9, enter overpayment ......................................................     17                           .00

18. Amount of line 17 to be credited to next year’s tax....................................................        18                           .00

19. Amount of line 17 to be refunded (subtract line 18 from line 17)...............................                19                           .00

20. If line 16 is smaller than line 9, enter tax due here....................................................      20                           .00

21. Interest for late payment (see instructions).................................................................  21                           .00

22. Additions to tax for late filing and/or late payment (see instructions)..........................              22                           .00

23. Penalty for underpayment of estimated tax ................................................................     23                           .00

24. TOTAL DUE with this return (add lines 20 through 23).............................................              24                           .00

Direct Deposit             CHECKING          SAVINGS
of Refund
                                                                                                           ROUTING NUMBER ACCOUNT NUMBER
                                       INCORRECT ACCOUNT INFORMATION MAY RESULT IN A $15.00 RETURNED PAYMENT CHARGE.
                                             PLEASE SEE PAGE 3 OF INSTRUCTIONS FOR PAYMENT OPTIONS.
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.

Signature of Officer/Partner or Member                               Print name of Officer/Partner or Member              Date

Title                                                                                       Email                         Business Telephone #

Signature of paid preparer                                           Print name of Preparer                               Date

Firm’s name and address                                                                     Preparer’s Email              Preparer’s Telephone #
MAIL TO:  WEST VIRGINIA TAX DIVISION
      TAX ACCOUNT ADMINISTRATION 
      PO BOX 1202 
      CHARLESTON WV 25324-1202
                                                                                                                      *B30202302W*
                                                                                                                          B30202302W