Schedule                NONRESIDENTS/PART-YEAR RESIDENTS
    A
    Form IT-140 B                                      SCHEDULE OF INCOME                                                                          2023
NONRESIDENT                PART-YEAR RESIDENTS                                                    FROM                                           TO
                           (Enter period of West Virginia residency MM/DD/YYYY)
(To Be Completed By Nonresidents and Part-Year Residents Only)                          COLUMN A:                         COLUMN B:                COLUMN C: 
                  INCOME                                                             AMOUNT FROM  FEDERAL RETURN  ALL INCOME DURING PERIOD       WV SOURCE INCOME DURING 
                                                                                                                  OF WV RESIDENCY                NONRESIDENT PERIOD

1  Wages, salaries, tips (withholding documents)                          1                        .00                            .00             .00

2  Interest  2                        .00                            .00             .00

3  Dividends     3                        .00                            .00             .00

4  IRAs, pensions and annuities                4                        .00                            .00             .00
5  Total taxable Social Security and Railroad Retirement 
    benefits (see line 32 and 38 of Schedule M) ................                     5                        .00                            .00
6  Refunds of state and local income tax 
    (see line 36 of Schedule M)              6                        .00                            .00

7  Alimony received          7                        .00                            .00

8  Business profit (or loss) ..............................................         8                        .00                            .00             .00

9  Capital gains (or losses)            9                        .00                            .00             .00

10 Supplemental gains (or losses)  10                                      .00                            .00             .00

11 Farm income (or loss)  11                                 .00                            .00             .00

12 Unemployment compensation insurance                            12                       .00                            .00             .00
13 Other income from federal return (identify source) 
                                                                                     13                       .00                            .00             .00

14 Total income (add lines 1 through 13)  14                                         .00                            .00             .00
ADJUSTMENTS

15 Educator expenses             15                       .00                            .00             .00

16 IRA deduction        16                       .00                            .00             .00

17 Self-employment tax deduction                   17                       .00                            .00             .00

18 Self Employed SEP, SIMPLE and qualified plans ......                             18                       .00                            .00             .00

19 Self-employment health insurance deduction  19                                                .00                            .00             .00

20 Penalty for early withdrawal of savings  20                                         .00                            .00             .00

21 Other adjustments (See instructions page 32)                          21                       .00                            .00             .00

22 Total adjustments (add lines 15 through 21)  22                                             .00                            .00             .00
23 Adjusted gross income  
    (subtract line 22 from line 14 in each column)  23                                            .00                            .00             .00
                                                                                     24 West Virginia income 
                                                                                        (line 23, Column B plus column C)                    24              .00
                                                                                     25 Income subject to West Virginia Tax but exempt 
                                                                                        from federal tax 25              .00
    *P40202307A* 26 Total West Virginia income (line 24 plus line 25)  
    P40202307A                                                                          Enter here and on line 2 on the next page            26              .00
                                                                                        –7–

   Schedule                          NONRESIDENTS/PART-YEAR RESIDENTS
   A
   Form IT-140 B                             SCHEDULE OF INCOME                                                                                                2023
                                             SCHEDULE A (CONTINUED)

 PART I: NONRESIDENT/PART-YEAR RESIDENT TAX CALCULATION

 1  Tentative Tax (apply the appropriate tax rate schedule on page 35 to the amount shown on line 7, Form IT-140)                                      1       .00

 2  West Virginia Income (line 26, Schedule A) 2       .00

 3  Federal Adjusted Gross Income (line 1, Form IT-140)       3       .00
 4  Tax (divide line 2 by line 3, round to 4 decimal places and multiply the result by line 1) 
 Enter here and on line 8, Form IT-140      4       .00
 PART II: SPECIAL NONRESIDENT INCOME FOR RESIDENTS OF RECIPROCAL STATES 
   AND CERTAIN ACTIVE MILITARY MEMBERS
 ELIGIBILITY:  Complete this section ONLY if ALL THREE of the following statements were true for 2023
 • You were EITHER a resident of Kentucky, Maryland, Ohio, Pennsylvania or Virginia 
   OR a member of the military assigned to active duty in West Virginia whose domicile is outside West Virginia
 • Your only West Virginia source income was from wages and salaries
 • West Virginia income tax was withheld from such wages and salaries by your employer(s)
 If you were a non-military, domiciliary resident of Pennsylvania or Virginia and spent more than 183 days in West Virginia, you are also considered a 
 resident of West Virginia and must file Form IT-140 as a resident of West Virginia.
 NOTE: If you were a resident of any state other than Kentucky, Ohio, Maryland, Pennsylvania, or Virginia, you are ineligible to complete Part 
 II. You must check the box Filing as Nonresident or Filing as a Part-Year Resident and Complete Schedule A and Part I to report any income 
 from West Virginia sources.
 I declare that I was not a resident of West Virginia at any time during 2023, I was a resident of the state shown OR was in West Virginia 
 pursuant to active duty military orders, my only income from sources within West Virginia was from wages and salaries, and such wages 
 and salaries were subject to income taxation by my state of residence.
                                             YOUR STATE OF RESIDENCE (Check one):
    1 Commonwealth of Kentucky        4 Commonwealth of Pennsylvania                Number of days spent in West Virginia

    2 State of Maryland               5 Commonwealth of Virginia                    Number of days spent in West Virginia

    3  State of Ohio                  6 Active Military, stationed in West Virginia but not domiciled here (Must enclose military order and DD2058)
                                                                                                               (A)                                             (B)
                                                                                                               Primary Taxpayer's Social                       Spouse's Social Security 
                                                                                                               Security Number                                 Number

 5  Enter your total West Virginia Income from wages and salaries in the appropriate column                 5                 .00                                   .00
 6  Enter total amount of West Virginia  Income Tax withheld  from your wages and 
 salaries paid by your employer in 2023  6                 .00                                   .00

 7  Line 6, column A plus line 6 column B Report this amount on line 15 of Form IT-140                            7       .00

                                                                                                               *P40202308A*
                                                                                                               P40202308A
                                                                 –8–