WEST VIRGINIA 
    REV 06-22IT-140 B                                                                                                                                       2023
                              PERSONAL INCOME TAX RETURN
                                                                                       **SPOUSE’S                                                   Deceased
  SOCIAL                               Deceased                             SOCIAL SECURITY                                                                                             
 SECURITY 
 NUMBER                                Date of Death*                                  NUMBER                                                       Date of Death*
                                                                                                           YOUR 
LAST NAME                                                                   SUFFIX                         FIRST                                                                        MI
                                                                                                           NAME
                                                                                                   SPOUSE’S 
 SPOUSE’S                                                                   SUFFIX                         FIRST                                                                        MI
LAST NAME                                                                                                  NAME
FIRST LINE                                                                             SECOND LINE 
OF ADDRESS                                                                             OF ADDRESS

    CITY                                                                    STATE                  ZIP CODE
                                                                                                                                                    EXTENDED  
TELEPHONE                              EMAIL                                                                                                        DUE DATE
 NUMBER                                                                                                                                             MM/DD/YYYY
* 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 
    AMENDED  RETURN      NONRESIDENT SPECIAL                                NONRESIDENT/PART YEAR RESIDENT       FORM WV-8379 FI LED AS AN INJURED SPOUSE

FILING STATUS            1 SINGLE      2 HEAD OF                            3 MARRIED,   4 MARRIED, FILING SEPARATE                                                                     5 WIDOW(ER) WITH 
    (CHECK ONE)                        HOUSEHOLD                            FILING JOINT          **Enter spouse’s SS# and name in the boxes above                                      DEPENDENT CHILD
EXEMPTIONS
(a) YOURSELF             To claim an exemption for yourself, enter 1 If someone can claim you as a dependent, leave box (a) blank)                                                    (a)

(b) SPOUSE               To claim an exemption for your spouse, enter 1 They may not be claimed as an exemption by anyone else                                                        (b)

(c) DEPENDENTS           List your dependents If over four dependents, continue on Schedule DP on page 49 Enter total number of dependents                                            (c) 
              Dependent First name                                          Dependent Last name                  Social Security Number                     Date of Birth (MM DD YYYY)

(d) SURVIVING SPOUSE     (See page 21) Decedents SSN                                     Year Spouse Died:
                                                                                                                                                                                        (d)
(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) 

1  Federal Adjusted Gross Income or income to claim senior citizen tax credit from Schedule SCTC-A                                               1                                         .00

2  Additions to income (line 59 of Schedule M)      2                                         .00

3  Subtractions from income (line 50 of Schedule M)          3                                         .00

4  West Virginia Adjusted Gross Income (line 1 plus line 2 minus line 3)                   4                                         .00

5  Low-Income Earned Income Exclusion (see worksheet on page 29)                         5                                         .00

6  Total Exemptions as shown above on Exemption Box (e) ________ x $2,000                                6                                         .00

7  West Virginia Taxable Income (line 4 minus lines 5 & 6) IF LESS THAN ZERO, ENTER ZERO                                             7                                         .00

8  Income Tax Due (Check One)   8                                         .00
         Tax Table       Rate Schedule          Nonresident/Part-year resident  
                                                calculation schedule
         TAX DEPT USE ONLY             MUST INCLUDE WITHHOLDING 
    PAY     COR     SCTC NRSR HEPTC    FORMS WITH THIS RETURN
    PLAN
                                                (W-2s, 1099s, Etc.)                                        *P40202301A*
                                                                                                                 P40202301A
                                                                            –1–

 PRIMARY LAST NAME                                                                                       SOCIAL SECURITY NUMBER

 9  Credits from Tax Credit Recap Schedule (see schedule on page 5 )              9             .00

 10 Total Income Tax Due Line 8 minus 9 If line 9 is greater than line 8, enter 0                                                           10            .00

 11 Overpayment previously refunded or credited (amended return only)              11            .00
 Penalty Due             CHECK IF REQUESTING WAIVER/ANNUALIZED
                                                                                  
 12 West Virginia Use Tax Due on out-of-state purchases  
 (See Schedule UT on page 44)                                                     CHECK IF NO USE TAX DUE .                     12            .00

 13 Add lines 10 through 12 This is your total amount due  13            .00
                                                                                   Check  if withholding  from NRSR  
 14 West Virginia Income Tax Withheld (See instructions page 23)                  (Nonresident Sale of Real Estate)                           14            .00

 15 Estimated Tax Payments and Payments with Schedule 4868             15            .00

 16 Non-Family Adoption Tax Credit, if applicable (include Schedule WV NFA-1)                 16            .00

 17 Senior Citizen Tax Credit for property tax paid (include Schedule SCTC-A)               17            .00

 18 Homestead Excess Property Tax Credit for property tax paid (include Schedule HEPTC-1 and Class 2 receipt)                                 18            .00

 19 Build WV Property Value Adjustment Refundable Tax Credit       19            .00

 20 Amount paid with original return (amended return only)    20            .00

 21 Payments and Refundable Credits (add lines 14 through 20)          21            .00

 22. Balance Due (line 13  minus line 21). If Line 21 is greater than line 13, complete line 23 ...  PAY THIS AMOUNT                           22            .00

 23 Line 21 minus line 13 This is your overpayment  23            .00
 24 Indicate donations from line 24 Enter below and enter the sum of columns 24A, 24B, and 24C on Line 24
 24A.                                    24B.                                      24C. 
 CHILDREN’S TRUST                       4WV DEPT. OF VETERANS                     STATE VETERANS 
 FUND                                    ASSISTANCE                                CEMETERY                                                    24            .00

 25 Amount of Overpayment to be credited to your 2024 estimated tax            25            .00

 26 Refund due to you (line 23 minus line 24 and line 25) REFUND                26            .00
 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 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.

Your Signature                           Date                       Spouse’s Signature                                   Date                     Telephone Number
 Preparer: Check 
 HERE if client is 
 requesting NOT 
 to efile
                         Preparer’s EIN  Signature of preparer other than above                                          Date                     Telephone Number

 Preparer’s Printed Name                 Preparer’s Firm
 FOR REFUND, MAIL TO THIS ADDRESS:            FOR BALANCE DUE, MAIL TO THIS ADDRESS:
                   WV TAX DIVISION                                  WV TAX DIVISION
                         PO BOX 1071                              PO BOX 3694
               CHARLESTON, WV 25324-1071                            CHARLESTON, WV 25336-3694
 Payment Options: Returns filed with a balance of tax due may pay through any of the following methods:                  *P40202302A*
 •  Check or Money Order payable to the WV Tax Division - Enclose check or money order with your return 
 •  Electronic Payment - May be made by visiting mytaxeswvtaxgov and clicking on “Pay Personal Income Tax”            P40202302A
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