67891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162636465666768697071 727374757677787980
4                                                                                                                                                                                          4
5                                                       WEST VIRGINIA                                                                                                                      5
6      REVIT-14006-22 B                                                                                                                                         2023                       6
                                PERSONAL INCOME TAX RETURN
7    SOCIAL                              Deceased                      **SPOUSE’S                                                                      Deceased                            7
8   SECURITY                                            SOCIAL SECURITY                                                                                                                    8
    NUMBER                               Date of Death*                NUMBER                                                                          Date of Death*
9                                                                                      YOUR                                                                                                9
10 LAST NAME                                                           SUFFIX          FIRST                                                                         MI                    10
                                                                                       NAME
11                                                                                 SPOUSE’S                                                                                                11
12  SPOUSE’S                                                           SUFFIX          FIRST                                                                         MI                    12
   LAST NAME                                                                           NAME
13 FIRST LINE                                                          SECOND LINE                                                                                                         13
14 OF ADDRESS                                                          OF ADDRESS                                                                                                          14
15                                                                                                                                                                                         15
16     CITY                                             STATE                      ZIP CODE                                                                                                16
17                                                                                                                                                     EXTENDED                            17
18 TELEPHONE                             EMAIL                                                                                                         DUE DATE                            18
    NUMBER                                                                                                                                             MM/DD/YYYY
19 * ONLY INLCLUDE A DECEASED TAXPAYER AND THEIR DATE OF DEATH IF IT OCCURRED IN THIS TAX YEAR FOR THE NEXT TWO YEARS, PLEASE LIST THEM BELOW ON THE SURVIVING SPOUSE EXPEMPTION 19
20     AMENDED  RETURN     NONRESIDENT SPECIAL          NONRESIDENT/PART YEAR RESIDENT       FORM WV-8379 FI LED AS AN INJURED SPOUSE                                                      20
21                                                                                                                                                                                         21
22 FILING STATUS           1 SINGLE      2 HEAD OF      3 MARRIED,            4 MARRIED, FILING SEPARATE                                                             5 WIDOW(ER) WITH      22
       (CHECK ONE)                       HOUSEHOLD      FILING JOINT              **Enter spouse’s SS# and name in the boxes above                                   DEPENDENT CHILD
23                                                                                                                                                                                         23
24 EXEMPTIONS                                                                                                                                                                              24
25 (a) YOURSELF            To claim an exemption for yourself, enter 1 If someone can claim you as a dependent, leave box (a) blank)                               (a)                   25
26                                                                                                                                                                                         26
27 (b) SPOUSE              To claim an exemption for your spouse, enter 1 They may not be claimed as an exemption by anyone else                                   (b)                   27
28                                                                                                                                                                                         28
29 (c) DEPENDENTS          List your dependents If over four dependents, continue on Schedule DP on page 49 Enter total number of dependents                       (c)                   29
30               Dependent First name                   Dependent Last name                     Social Security Number                                          Date of Birth (MM DD YYYY) 30
31                                                                                                                                                                                         31
32                                                                                                                                                                                         32
33                                                                                                                                                                                         33
34                                                                                                                                                                                         34
35                                                                                                                                                                                         35
36                                                                                                                                                                                         36
37                                                                                                                                                                                         37
38                                                                                                                                                                                         38
39                                                                                                                                                                                         39
40 (d) SURVIVING SPOUSE    (See page 21) Decedents SSN                        Year Spouse Died:                                                                                            40
                                                                                                                                                                     (d)
41                                                                                                                                                                                         41
42 (e) Total Exemptions    (add boxes a, b, c, and d) Enter here and on line 6 below If box e is zero, enter $500 on line 6 below                                 (e)                   42
43                                                                                                                                                                                         43
44 1  Federal Adjusted Gross Income or income to claim senior citizen tax credit from Schedule SCTC-A                                               1                        .00          44
45                                                                                                                                                                                         45
46 2  Additions to income (line 59 of Schedule M)      2                        .00          46
47                                                                                                                                                                                         47
48 3  Subtractions from income (line 50 of Schedule M)          3                        .00          48
49                                                                                                                                                                                         49
50 4  West Virginia Adjusted Gross Income (line 1 plus line 2 minus line 3)                   4                        .00          50
51                                                                                                                                                                                         51
52 5  Low-Income Earned Income Exclusion (see worksheet on page 29)                         5                        .00          52
53                                                                                                                                                                                         53
54 6  Total Exemptions as shown above on Exemption Box (e) ________ x $2,000                                6                        .00          54
55                                                                                                                                                                                         55
56 7  West Virginia Taxable Income (line 4 minus lines 5 & 6) IF LESS THAN ZERO, ENTER ZERO                                             7                        .00          56
57                                                                                                                                                                                         57
58 8  Income Tax Due (Check One)   8                        .00          58
59          Tax Table      Rate Schedule          Nonresident/Part-year resident                                                                                                           59
60                                                calculation schedule                                                                                                                     60
61          TAX DEPT USE ONLY            MUST INCLUDE WITHHOLDING                                                                                                                          61
       PLAN
62     PAY    COR     SCTC NRSR HEPTC    FORMS WITH THIS RETURN                                                                                                                            62
                                                  (W-2s, 1099s, Etc.)                  *P40202301A*
63                                                                                           P40202301A                                                                                    63
   67891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162636465666768697071 727374757677787980
                                                        –1–

   67891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162636465666768697071 727374757677787980
4                                                                                                                                                                                               4
5   PRIMARY LAST NAME                                                                                       SOCIAL SECURITY NUMBER                                                              5
6                                                                                                                                                                                               6
7   9  Credits from Tax Credit Recap Schedule (see schedule on page 5 )              9              .00                            7
8                                                                                                                                                                                               8
9   10 Total Income Tax Due Line 8 minus 9 If line 9 is greater than line 8, enter 0                                                           10             .00                            9
10                                                                                                                                                                                              10
11  11 Overpayment previously refunded or credited (amended return only)              11             .00                            11
12  Penalty Due             CHECK IF REQUESTING WAIVER/ANNUALIZED                                                                                                                               12
13                                                                                                                                                                                              13
14  12 West Virginia Use Tax Due on out-of-state purchases                                                                                                                                     14
    (See Schedule UT on page 44)                                                      CHECK IF NO USE TAX DUE .                    12             .00
15                                                                                                                                                                                              15
16  13 Add lines 10 through 12 This is your total amount due  13             .00                            16
17                                                                                                                                                                                              17
                                                                                       Check  if withholding  from NRSR  
18  14 West Virginia Income Tax Withheld (See instructions page 23)                   (Nonresident Sale of Real Estate)                          14             .00                            18
19                                                                                                                                                                                              19
20  15 Estimated Tax Payments and Payments with Schedule 4868             15             .00                            20
21                                                                                                                                                                                              21
22  16 Non-Family Adoption Tax Credit, if applicable (include Schedule WV NFA-1)                 16             .00                            22
23                                                                                                                                                                                              23
24  17 Senior Citizen Tax Credit for property tax paid (include Schedule SCTC-A)               17             .00                            24
25                                                                                                                                                                                              25
26  18 Homestead Excess Property Tax Credit for property tax paid (include Schedule HEPTC-1 and Class 2 receipt)                                 18             .00                            26
27                                                                                                                                                                                              27
28  19 Build WV Property Value Adjustment Refundable Tax Credit       19             .00                            28
29                                                                                                                                                                                              29
30  20 Amount paid with original return (amended return only)    20             .00                            30
31                                                                                                                                                                                              31
32  21 Payments and Refundable Credits (add lines 14 through 20)          21             .00                            32
33                                                                                                                                                                                              33
34  22. Balance Due (line 13  minus line 21). If Line 21 is greater than line 13, complete line 23 ...  PAY THIS AMOUNT                           22             .00                            34
35                                                                                                                                                                                              35
36  23 Line 21 minus line 13 This is your overpayment  23             .00                            36
37  24 Indicate donations from line 24 Enter below and enter the sum of columns 24A, 24B, and 24C on Line 24                                                                                  37
38  24A.                                    24B.                                       24C.                                                                                                     38
    CHILDREN’S TRUST                       4WV DEPT. OF VETERANS                     STATE VETERANS 
39  FUND                                    ASSISTANCE                                 CEMETERY                                                   24             .00                            39
40                                                                                                                                                                                              40
41  25 Amount of Overpayment to be credited to your 2024 estimated tax            25             .00                            41
42                                                                                                                                                                                              42
43  26 Refund due to you (line 23 minus line 24 and line 25) REFUND                26             .00                            43
44                                                                                                                                                                                              44
    Direct Deposit             
45                                                                                                                                                                                              45
46  of Refund                  CHECKING                                SAVINGS       ROUTING NUMBER                                               ACCOUNT NUMBER                                46
47  PLEASE REVIEW YOUR ACCOUNT INFORMATION FOR ACCURACY. INCORRECT ACCOUNT INFORMATION MAY RESULT IN A $15.00 RETURNED PAYMENT CHARGE.                                                          47
48  I authorize the Tax Division to discuss my return with my preparer YES     NO                                                                                                               48
49  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. 49
50                                                                                                                                                                                              50
51                                                                                                                                                                                              51
52 Your Signature                           Date                       Spouse’s Signature                                   Date                     Telephone Number                           52
53  Preparer: Check                                                                                                                                                                             53
    HERE if client is 
54  requesting NOT                                                                                                                                                                              54
    to efile
55                          Preparer’s EIN  Signature of preparer other than above                                          Date                     Telephone Number                           55
56                                                                                                                                                                                              56
57                                                                                                                                                                                              57
58                                                                                                                                                                                              58
59  Preparer’s Printed Name                 Preparer’s Firm                                                                                                                                     59
60  FOR REFUND, MAIL TO THIS ADDRESS:            FOR BALANCE DUE, MAIL TO THIS ADDRESS:                                                                                                         60
61                    WV TAX DIVISION                                  WV TAX DIVISION                                                                                                          61
                            PO BOX 1071                              PO BOX 3694
                  CHARLESTON, WV 25324-1071                            CHARLESTON, WV 25336-3694
62  Payment Options: Returns filed with a balance of tax due may pay through any of the following methods:                  *P40202302A*                                                        62
    •  Check or Money Order payable to the WV Tax Division - Enclose check or money order with your return 
63  •  Electronic Payment - May be made by visiting mytaxeswvtaxgov and clicking on “Pay Personal Income Tax”            P40202302A                                                          63
   67891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162636465666768697071 727374757677787980
                                                                                   –2–