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4 FORM 4
West Virginia
5 BAR-0 WEST VIRGINIA BUSINESS ACTIVITY REPORT Tax Division 5
6 REV09-2023 6
7 (Read the instructions on the back to determine if you must file this form) 7
If you need more space to complete any answers on this form, please print or type your answers on a separate sheet of paper.
8 SECTION A: BUSINESS IDENTIFICATION 8
9 9
1 FEIN WV TAX ID
10 10
11 TAX PERIOD 11
12 12
2 BEGINNING ENDING
13 13
14 MM DD YYYY MM DD YYYY 14
NAME OF CORPORATION OR PARTNERSHIP PRINCIPAL OFFICE IN WEST VIRGINIA
15 15
16 16
STREET ADDRESS STREET ADDRESS
17 3 17
18 CITY STATE ZIP CITY STATE ZIP 18
19 19
20 20
21 UNITARY GROUP? YES NO 5 HAVE YOU MADE LOANS, OR LEASES OR SALES OF PRODUCTS YES NO 21
AND SERVICES IN WEST VIRGINIA DURING THE TAXABLE YEAR?
22 4 ARE YOU A MEMBER OF: 22
AFFILIATED GROUP? YES NO 6 STATE OF COMMERCIAL DOMICILE
23 23
24 PRINCIPAL TYPES OF 8 TOTAL AMOUNT OF WEST VIRGINIA SALES (WHOLESALE OR 24
25 RETAIL) AND/OR GROSS RECEIPTS ATTRIBUTE TO WEST VIRGINIA. $ .00 25
7 BUSINESS, PRODUCTS
26 AND SERVICES 9 TOTAL AMOUNT OF EVERYWHERE SALES (WHOLESALE OR 26
27 RETAIL) AND/OR GROSS RECEIPTS. $ .00 27
28 OFFICES AND OTHER PLACES OF BUSINESS OWNED OR MAINTAINED IN WEST VIRGINIA DURING THE TAXABLE YEAR: 28
29 LOCATIONS (INCLUDE FULL ADDRESS IF DIFFERENT FROM ABOVE) TYPE OF ACTIVITIES FOR EACH LOCATION 29
10
30 30
31 31
32 Number of o fficers, employees, independent contractors, representatives or other agents with business activity in West Virginia on behalf of your 32
11 business. Attach a brief job description for each o fficer and type of agent and indicate the number of each with any activity in this State regardless
33 of whether they reside or are regularly stationed in West Virginia. 33
34 SECTION B: BUSINESS IDENTIFICATION 34
35 Please read instructions on back of this form carefully before completing this section and check all applicable boxes. 35
36 Explain all “yes” answers in detail on a separate sheet. You may also be required to answer a West Virginia nexus questionnaire or otherwise provide 36
additional information if your explanations do not provide a clear picture of your taxability.
37 37
38 During the period covered by this report, did the corporation – Yes NO 38
39 1 Own, rent, lease or maintain tangible or intangible personal property or real property in West Virginia? 1 39
40 40
2 Employ or own any other assets in West Virginia? 2
41 41
42 3 Own or consign any merchandise located in West Virginia? 3 42
43 4 Own assets located in West Virginia that are leased to others? 4 43
44 5 Perform any training, consultation, installation, or repair work in West Virginia? 5 44
45 45
46 6 Derive income from service performed for other businesses or persons located in West Virginia? 6 46
47 7 Derive income from any source or activity within West Virginia, including income from activities conducted by independent 7 47
contractors, representatives or other agents, or by subsidiaries or a ffiliated entities?
48 48
49 8 Derive income or other receipts from any financial transactions in West Virginia, including: loans secured by real or tangible property; 5 49
consumer loans; commercial loans and installment obligations; syndication and participation loans; credit card services charges and
50 fees; credit card merchant discount income; performance of financial or fiduciary services; travelers checks and money orders; and 50
any other receipts not attributable to another state where the organization is taxable?
51 51
9 In any other way carry on business activity or maintain property within West Virginia (as described on back of this form)? 6
52 52
53 SECTION C: SIGNATURE 53
54 By my signature I hereby certify that this report, including any accompanying material, is true, correct and complete to the best of my knowledge and belief. 54
55 55
56 SIGNATURE OF OFFICER OR PARTNER NAME OF OFFICER OR PARTNER (PRINT OR TYPE) 56
57 57
58 TITLE DATE TELEPHONE 58
59 Mail to: West Virginia Tax Division 59
60 Tax Account Administration 60
61 P.O. Box 1202 61
62 62
Charleston, WV 25324-1202 *B30032301W*
63 B30032301W 63
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