WV4868 B
Form IT-140     APPLICATION FOR EXTENSION OF TIME TO FILE
File this form to request a six-month extension of time to file your West Virginia Personal Income Tax Return 
Request for extension to file must be filed before the original due date of the return Extensions received after this date will be denied 
Your return must be filed no later than October 17 after the original due date 

This form is NOT an extension of time to PAY personal income taxes due 
                TAX YEAR 
ENDING  
MM DD YYYY
                               TAXPAYER INFORMATION
SOCIAL SECURITY                *SPOUSE’S SOCIAL 
NUMBER                         SECURITY NUMBER
                                                                                YOUR 
LAST NAME                      SUFFIX                                           FIRST                                                                                 MI
                                                                                NAME
                                                                                SPOUSE’S 
SPOUSE’S                       SUFFIX                                           FIRST                                                                                 MI
LAST NAME                                                                       NAME
FIRST LINE OF                  SECOND LINE OF 
ADDRESS                            ADDRESS

CITY                           STATE                                            ZIP CODE

TELEPHONE                EMAIL                                                        EXTENDED DUE DATE
NUMBER                                                                                                                                                      MM/DD/YYYY

                               CALCULATION

a Total income tax liability a          .00

b Total payments (West Virginia withholding and/or credit for estimated payments)                                       b          .00

c Amount of West Virginia personal income tax due (subtract line b from line a)                                    c          .00

                               NOTE

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 
of tax unless reasonable cause can be shown If you receive an extension of time for federal income purposes and expect to 
owe no West Virginia income tax, you are not required to file this form. To receive the same extension for state tax purposes, 
you need only note on your West Virginia Personal Income Tax Return that a federal extension was granted 

                               Mail this form to:
                               West Virginia Tax Division
                               Tax Account Administration
                               PO Box 2585
                               Charleston, WV 25329-2585

                This form must be complete and submitted in full.

                         DO NOT CUT OR RESIZE THIS FORM.

                                                                                *P40012201A*
                                                                                    P40012201A
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