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   WV4868 B
6  Form IT-140     APPLICATION FOR EXTENSION OF TIME TO FILE                                                                                                                     6
7 File this form to request a six-month extension of time to file your West Virginia Personal Income Tax Return                                                                 7
8 Request for extension to file must be filed before the original due date of the return Extensions received after this date will be denied                                    8
9 Your return must be filed no later than October 17 after the original due date                                                                                                9
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11 This form is NOT an extension of time to PAY personal income taxes due                                                                                                       11
12                 TAX YEAR                                                                                                                                                      12
13 ENDING                                                                                                                                                                        13
14 MM DD YYYY                                                                                                                                                                    14
15                                TAXPAYER INFORMATION                                                                                                                           15
16 SOCIAL SECURITY                *SPOUSE’S SOCIAL                                                                                                                               16
17 NUMBER                         SECURITY NUMBER                                                                                                                                17
18                                                                                YOUR                                                                                           18
19 LAST NAME                      SUFFIX                                          FIRST                                                                                   MI     19
                                                                                  NAME
20                                                                                SPOUSE’S                                                                                       20
21 SPOUSE’S                       SUFFIX                                          FIRST                                                                                   MI     21
   LAST NAME                                                                      NAME
22 FIRST LINE OF                  SECOND LINE OF                                                                                                                                 22
23 ADDRESS                            ADDRESS                                                                                                                                    23
24                                                                                                                                                                               24
25 CITY                           STATE                                           ZIP CODE                                                                                       25
26 TELEPHONE                EMAIL                                                       EXTENDED DUE DATE                                                                        26
27 NUMBER                                                                                                                                                      MM/DD/YYYY        27
28                                                                                                                                                                               28
29                                CALCULATION                                                                                                                                    29
30                                                                                                                                                                               30
31 a Total income tax liability a            .00 31
32                                                                                                                                                                               32
33 b Total payments (West Virginia withholding and/or credit for estimated payments)                                       b            .00 33
34                                                                                                                                                                               34
35 c Amount of West Virginia personal income tax due (subtract line b from line a)                                    c            .00 35
36                                                                                                                                                                               36
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                                  NOTE
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40 This form and payment must be filed on or before the due date of the return. A penalty is imposed for late filing/late payment                                                40
41 of tax unless reasonable cause can be shown If you receive an extension of time for federal income purposes and expect to                                                    41
42 owe no West Virginia income tax, you are not required to file this form. To receive the same extension for state tax purposes,                                                42
   you need only note on your West Virginia Personal Income Tax Return that a federal extension was granted 
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45                                Mail this form to:                                                                                                                             45
46                                West Virginia Tax Division                                                                                                                     46
                                  Tax Account Administration
47                                                                                                                                                                               47
48                                PO Box 2585                                                                                                                                  48
                                  Charleston, WV 25329-2585
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53                 This form must be complete and submitted in full.                                                                                                             53
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55                          DO NOT CUT OR RESIZE THIS FORM.                                                                                                                      55
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63                                                                                *P40012201A*                                                                                   63
                                                                                      P40012201A
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