WEST VIRGINIA FIDUCIARY INCOME TAX RETURN
REVIT-14107/2023                                  (for resident and non-resident estates and trusts)                                                                             2023
Estate or                                                                                       FEIN
Trust Name
Trustee Executor 
Name
FIRST LINE OF                                                                SECOND LINE OF 
ADDRESS                                                                          ADDRESS

CITY                                                                        STATE               ZIP
FILING PERIOD                       EXTENDED                                 FISCAL YEAR FILER  CHECK ONE:                                                            CHECK IF APPLICABLE:
ENDED                               DUE DATE
MM DD YYYY                          MM DD YYYY                                                       Resident Non-Resident                                                       Final Amended
TYPE OF ENTITY
SIMPLE           COMPLEX       DECEDENT’S         CH7           CH11    QUALIFIED               POOLED                                                          ESBT                   GRANTOR 
TRUST            TRUST         ESTATE                                   DISABILITY TRUST        INCOME FUND                                                     (S portion only)       TYPE TRUST
                                                       Bankruptcy estate
DECEDENT         Date of Death                                          SSN                                                                                     Final Individual Return  
INFO             MM/DD/YYYY                                                                                                                                     Filed for Decedent

1.    Federal taxable income (enter line 23, Federal Form 1041 or line 11, 1041-QFT) .............................................                              1                                .00

2.    West Virginia fiduciary additions (Schedule B, line 6) ........................................................................................           2                                .00

3.    West Virginia fiduciary subtractions (Schedule B, line 11) ..................................................................................             3                                .00

4.    West Virginia taxable income (sum of lines 1 and 2 minus line 3) ......................................................................                   4                                .00
                               IF THIS IS A SIMPLE TRUST HAVING NO TAXABLE INCOME, OMIT LINES 5-7

5.    West Virginia tax (check one)  Rate Schedule               Schedule NR     ...................................................                            5                                .00

6.    Credits from Tax Credit Recap Schedule (see schedule page 6) ........................................................................                     6                                .00

7.    Adjusted tax due (line 5 minus line 6) .................................................................................................................. 7                                .00

8.    Non-resident income subject to tax (total of income for Beneficiaries, column F) ...............................................                          8                                .00

9.    West Virginia income tax paid for non-resident beneficiaries (total of Withholding for Beneficiaries, Column H)                                           9                                .00

10.  Combined tax due (sum of lines 7 and 9) ..............................................................................................................     10                               .00
11.  West Virginia fiduciary income tax withheld (See Instructions) 
  CHECK HERE IF WITHHOLDING IS FROM NRSR (NON RESIDENT SALE OF REAL ESTATE) ...................................................                                 11                               .00

12.  Refundable Credit (Build WV) ............................................................................................................................  12

13.  Estimated payments/payments with extension of time .........................................................................................               13                               .00

14.  Paid with original return (amended return only) ....................................................................................................       14                               .00

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

16.  Total payments (sum of lines 11, 12, 13, and 14 minus line 15) ............................................................................                16                               .00

17.  Balance of tax due (line 10 minus line 16) ............................................................................................................    17                               .00
                                                       18.    Overpayment  (if  line  16  is  larger  than  line  10, 
                                                       enter amount) .............................................................                              18                               .00

                                                       19.  Amount of line 18 to be credited to next year’s tax                                                 19                               .00

*P35202301W*                                           20.  Amount to be refunded (line 18 minus line 19) ....                                                  20                               .00
    P35202301W
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    Schedule         WITHHOLDING FOR BENEFICIARIES AND  
    SB
    Form IT-141      NON-RESIDENT TAX PAID FOR WITHHOLDING                            2023
                ATTACH ADDITIONAL COPIES OF WITHHOLDING FOR BENEFICIARIES AS NEEDED
                       NAME AND ADDRESS OF EACH BENEFICIARY
                NAME         STREET OR MAILING ADDRESS           CITY                 STATE ZIP CODE
1   

2   

3   

4   

5   

6  

7   

8   

9   

10  
       (A)                                              (E)      (F)                  (G)   (H)
                                                                 BENEFICIARY SHARE OF RATE  TAX PAID FOR 
SOCIAL SECURITY       WEST VIRGINIA FILING METHOD     IF NRW-4 WV INCOME                  BENEFICIARIES 
       #        (B) RESIDENT (C) COMPOSITE (D) NONRES PREVIOUSLY                            WITHHOLDING
                                                      FILED
1                                                                                     6.5%

2                                                                                     6.5%

3                                                                                     6.5%

4                                                                                     6.5%

5                                                                                     6.5%

6                                                                                     6.5%

7                                                                                     6.5%

8                                                                                     6.5%

9                                                                                     6.5%

10                                                                                    6.5%

TOTALS                                                                                6.5%

                                                                 *P35202302W*
                                                                 P35202302W
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   SCHEDULE 
     B
   Form IT-141     WEST VIRGINIA FIDUCIARY MODIFICATIONS                                                                             2023
                                                                                                                                     COLUMN II:AMOUNT ALLOCATED
                                                                                                                 COLUMN I:TOTAL      If this is a Simple Trust having  
ADDITIONS:                                                                                                                           NO Taxable Income, OMIT Col. II

1.  Interest income on state and municipal bonds, other than West Virginia .........

2.  Lump sum distribution (Federal Form 4972) .....................................................

3.  Federal exemption (Form 1041, line 21) ...........................................................

4.  Other additions – state nature and source ___________________________....

5.  Electing small business trust additions ..............................................................
6. TOTAL ADDITIONS 
   (Add Lines 1 through 5, Col. II and enter here and on Page 1, Line 2)..............
SUBTRACTIONS:                                                                                                    COLUMN I:TOTAL      COLUMN II:AMOUNT ALLOCATED

7. Interest income on US obligations specifically exempt from state tax ...............
8.  West Virginia exemption .................................................................................... 600.00                                                                    600.00

9.  Other subtractions – state nature and source ________________________ ...

10. Electing small business trusts subtractions .......................................................
11. TOTAL SUBTRACTIONS 
   (Add Lines 7 through 10, Col. II and enter here and on Page 1, Line 3) .........
NET FIDUCIARY MODIFICATIONS                                                                                      COLUMN I:TOTAL      COLUMN II:AMOUNT ALLOCATED

12. NET FIDUCIARY MODIFICATIONS (Line 6 minus Line 11) 

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 State 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 Fiduciary or Officer Representing Fiduciary)                                             (Date)                 (Email)

Paid       (Signature of Preparer)                                                                                                                                        (Date)
Preparer’s
Use Only
           (Preparer’s EIN)                                                 (Printed Name)                                                                 (Telephone Number)

                                                                                                                 *P35202303W*
                                                                                                                 P35202303W
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