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4                                                                                                                                                                                                  4
5                                                         WEST VIRGINIA TAX RETURN                                                                                                                 5
6      REVPTE-10007/2023  W   S CORPORATION & PARTNERSHIP                                                                          (PASS-THROUGH ENTITY)                     2023                  6
7  TAX PERIOD BEGINNING                                       ENDING                                                                                   EXTENDED                                    7
8                 MM/DD/YYYY                              MM/DD/YYYY                                                                                          DUE DATE                             8
                                                                                                                                                              MM/DD/YYYY
9  ENTITY NAME                                                                                                                     FEIN                           WV ACCOUNT NUMBER                9
10                                                                                                                                                                                                 10
11                                                                                                                                                                                                 11
12 MAILING ADDRESS                                                                                                                 HAS THE PARTNERSHIP ELECTED OUT OF THE CENTRALIZED AUDIT REGIME 12
13                                                                                                                                 UNDER IRC SECTION 6221(b)?                                      13
14                                                                                                                                                    IF NO, PROVIDE A DESIGNATION OF THE STATE    14
                                                                                                                                    Yes NO            PARTNERSHIP REPRESENTATIVE (OR THE FEDERAL 
15 CITY                                           STATE   ZIP                                                                                         PARTNERSHIP REPRESENTATIVE)                  15
16                                                                                                                                 REPRESENTATIVE FIRST NAME     LAST NAME                         16
17                                                                                                                                                                                                 17
18 STATE OF DOMICILE             NAICS                                                                                                                                                             18
19                                                        CHANGE OF                                                                REPRESENTATIVE TIN            REPRESENTATIVE US PHONE           19
                                                          ADDRESS
20                                                                                                                                                                                                 20
21 CONTACT FIRST NAME            CONTACT LAST NAME                                                                                                                                                 21
22                                                                                                                                 REPRESENTATIVE US ADDRESS                                       22
23                                                                                                                                                                                                 23
24 CONTACT PHONE                 CONTACT EMAIL                                                                                                                                                     24
25                                                                                                                                                                                                 25
26                                                                                                                                                                                                 26
27                                                                                                                                                                                                 27
                                                                                                                        1) ENTITY  S-CORPORATION              PARTNERSHIP
28 CHECK ALL APPLICABLE BOXES                                                                                                 TYPE (INCLUDE 1120S)            (INCLUDE 1065)                       28
29                                                                                                                                                                                                 29
30 2) RETURN TYPE         ANNUAL                  INITIAL                                                               FINAL      AMENDED                    AAR             OTHER                30
31                                                                                                                                                                                                 31
32                        52/53 WEEK FILER DAY OF WEEK ENDING                                                                                                 FISCAL                               32
33                                                                                                                                                                                                 33
34 3) IF FINAL/SHORT/     CEASED OPERATIONS IN WV         CHANGE OF OWNERSHIP                                                      CHANGE OF FILING STATUS           MERGER                        34
       INITIAL RETURN
35                                                                                                                                                                                                 35
36                        SUCCESSOR  FEIN OF PREDECESSOR:                                                                          TECHNICAL TERMINATIONS            OTHER                         36
37                                                                                                                                                                                                 37
38 4) ACTIVITY DESCRIPTION:                       WHOLLY WV ACTIVITY                                                               MULTISTATE ACTIVITY                                             38
                                                  (WV ACTIVITY ONLY)
39                                                                                                                                                                                                 39
   5) REPORTABLE ENTITIES (ALL ENTITIES MUST BE INCLUDED ON SCHEDULE D):
40                                                                                                                                                                                                 40
41                        A. ANY PTE YOU ARE A PARTNER, MEMBER, OR SHAREHOLDER DOING BUSINESS IN WV                                                                                                41
42                                                                                                                                                                                                 42
43                        B. ANY ENTITY YOU OWN 80% OF VOTING STOCK                                                                D. ANY DISREGARDED ENTITY, INCLUDING QSUBS                      43
44                                                                                                                                                                                                 44
45                        C. ANY ENTITY THAT OWNED MORE THAN 80% OF YOUR STOCK                                                     E. ANY CONTROLLED FOREIGN CORPORATION                           45
46                                                                                                                                      (A) INCOME                           (B) WITHHOLDING       46
47                                                                                                                                                                                                 47
48 6)  WV DISTRIBUTIVE INCOME OF RESIDENTS...............................................................                                                     .00                                  48
49 7)  WV DISTRIBUTIVE INCOME OF NONRESIDENTS FILING ON A NONRESIDENT                                                                                                                              49
50     COMPOSITE TAX RETURN AND WITHHOLDING DUE                                                                                                                                                    50
       (SCHEDULE SP, COLUMN F).......................................................................................                                         .00                               .00
51 8)  WV DISTRIBUTIVE INCOME OF NONRESIDENTS SUBJECT  TO WV                                                                                                                                       51
52     WITHHOLDING  THAT ARE NOT FILING A NONRESIDENT COMPOSITE  TAX                                                                                                                               52
       RETURN AND WITHHOLDING DUE (SCHEDULE SP, COLUMN G) ..............                                                                                      .00                               .00
53 9)  WV DISTRIBUTIVE INCOME OF NONRESIDENTS WHO HAVE ATTESTED ON A                                                                                                                               53
54     NRW-4 THAT THEY WILL FILE AND PAY WV INCOME TAX DIRECTLY OR ARE                                                                                                                             54
       TAX EXEMPT ENTITIES ............................................................................................                                       .00
55 10) TOTAL WV INCOME                                                                                                                                                                             55
56     (SUM OF LINE 6 THROUGH 9, MUST MATCH SCHEDULE A, LINE 13)...................                                                                           .00                                  56
57                                                                                                                                                                                                 57
58 11) TOTAL WV WITHHOLDING DUE (LINE 7 PLUS LINE 8)..................................                                                                                                             58
                                                                                                                                                                                                .00
59                                                                                                                                                                                                 59
60                                                                                                                                                                                                 60
61                                                                                                                                                                                                 61
62                                                                                                                                      *B54202301W*                                               62
63                                                                                                                                         B54202301W                                              63
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   67891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162636465666768697071 727374757677787980
4                                                                                                                                                                                              4
5                                                                                                                                                                                              5
6           NAME                                                                                                                 FEIN                                                          6
7                                                                                                                                                                                              7
8  11. Total WV withholding due (from previous page).........................................................                 11                     .00                                       8
9                                                                                                                                                                                              9
10 12. Prior year carryforward credit...................................................................      12                           .00                                                 10
11                                                                                                                                                                                             11
12 13. Estimated and extension payments.........................................................              13                           .00                                                 12
13 14. Total Withholding credits (see instructions) ............................................                                                                                               13
14          CHECK HERE IF WITHHOLDING IS FROM NRSR (NONRESIDENT SALE OF REAL ESTATE)                          14                           .00                                                 14
15                                                                                                                                                                                             15
16 15. Payments (add lines 12 through 14; must match total on Schedule C)                                                     15                     .00                                       16
17                                                                                                                                                                                             17
18 16. Overpayment previously refunded or credited (amended return only) ......................                               16                     .00                                       18
19                                                                                                                                                                                             19
20 17. TOTAL PAYMENTS (subtract line 16 from line 15)...................................................                      17                     .00                                       20
21 18. Tax Due – If line 17 is smaller than line 11, enter amount owed. If line 17 is larger                                                                                                   21
22     than line 11 skip to Line 22 ........................................................................................  18                     .00                                       22
23                                                                                                                                                                                             23
24 19. Interest for late payment............................................................................................. 19                     .00                                       24
25                                                                                                                                                                                             25
26 20. Additions to tax for late filing and/or late payment.......................................................            20                     .00                                       26
27                                                                                                                                                                                             27
28 21. Total Due with this return (add lines 18 through 20)  ................................................                 21                           .00                                 28
29                                                                                                                                                                                             29
30 22. Overpayment (Line 17 less line 11).........................................................            22                           .00                                                 30
31                                                                                                                                                                                             31
32 23. Amount of line 22 to be credited to next year’s tax ................................                   23                           .00                                                 32
33                                                                                                                                                                                             33
34 24. Amount to be refunded (line 22 minus line 23)........................................                  24                           .00                                                 34
35                                                                                                                                                                                             35
36                                                                                                                                                                                             36
  Direct Deposit               CHECKING                            SAVINGS
37 of Refund                                                                                                                                                                                   37
38                                                                                                              ROUTING NUMBER        ACCOUNT NUMBER                                           38
39          PLEASE REVIEW YOUR ACCOUNT INFORMATION FOR ACCURACY. INCORRECT ACCOUNT INFORMATION MAY RESULT IN A $15.00 RETURNED PAYMENT CHARGE.                                                 39
                                                             PLEASE SEE PAGE 3 OF INSTRUCTIONS FOR PAYMENT OPTIONS.
40                                                                                                                                                                                             40
41 I authorize the State Tax Department to discuss my return with my preparer                   YES    NO                                                                                      41
42 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. 42
43                                                                                                                                                                                             43
44                                                                                                                                                                                             44
45 Signature of Officer/Partner or Member                            Print name of Officer/Partner or Member                          Date                                                     45
46                                                                                                                                                                                             46
47                                                                                                                                                                                             47
48 Title                                                                                                  Email                       Business Telephone #                                     48
49                                                                                                                                                                                             49
50                                                                                                                                                                                             50
51 Signature of paid preparer                                        Print name of Preparer                                           Date                                                     51
52                                                                                                                                                                                             52
53                                                                                                                                                                                             53
54                                                                                                                                                                                             54
55 Firm’s name and address                                                                                Preparer’s Email            Preparer’s Telephone #                                   55
56                                                                                                                                                                                             56
57                                                                                                                                                                                             57
58 MAKE CHECKS PAYABLE TO AND MAIL TO:  WEST VIRGINIA TAX DIVISION                                                                                                                             58
                                                                                  TAX ACCOUNT ADMINISTRATION  
59                                                                                PO BOX 11751                                                                                                 59
60                                                                                CHARLESTON WV 25339-1751                                                                                     60
            
61                                                                                                                                                                                             61
62                                                                                                                                                                                             62
63                                                                                                                               *B54202302W*                                                  63
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