West Virginia 
                        West Virginia Nonresident Income Tax Agreement
NRW-4                                                                                                                                                                      State Tax 
REV. 02/2024                                      Read Instructions on Reverse Side                                                                                        Department
                                                                           Part I
ORGANIZATION NAME AND MAILING ADDRESS                                              NONRESIDENT NAME AND MAILING ADDRESS
Name (please type or print)                                                Name (please type or print)

Post Office or Street Address                                              Post Office or Street Address

City/Town                                    State                Zip Code City/Town                                      State                 Zip Code

          West Virginia                           Federal                  Social Security Number or Federal                                                               Spouse’s
    Identification Number               Identification Number                      Identification Number        Social Security Number

Type of Organization: (check only one)                                     Type of Nonresident:
  Partnership           S Corporation     Estate                             Individual        Corporation        Partnership
  Trust                 Limited Liability Company                          Nonresident’s Taxable Year:
Taxable Year of Organiation:                                                Calender Year
  Calender Year                                                             Fiscal Year Ending ________________________________________
  Fiscal Year Ending ____________________________                          State of Residence or Commercial Domicile:_______________________
State of Commercial Domicile: ______________________

Internal Revenue Service center where organization’s federal return        Internal Revenue Service center where nonresident’s federal return is 
is filed:                                                                  filed:
City____________________________________  State______________              City____________________________________ State_______________
                                                                           Part II
I declare that the above-named Distributee is a nonresident of West Virginia and that the nonresident Distributee hereby agrees to timely file West 
Virginia Income Tax Returns (Form IT-140, CIT-120, or PTE-100) and pay any income tax due; that the Distributee will include in that return the portion 
of the above-named Organization’s West Virginia income or gain attributable to the nonresident Distributee’s interest in such Organization for the 
taxable year of the Distributee during which this Form is filed with the Organization and for each succeeding taxable year for which the Distributee 
receives actual or deemed distributions of West Virginia source income or gain; and that this Agreement remains in effect until it is revoked by either the 
Distributee or the Tax Commissioner.
SIGN
HERE
          (Signature of Nonresident Partner, Shareholder, or Beneficiary, or of an Authorized Corporate Officer)

          (Print Name Signed Above

          (Mailing Address if Different from above)                                                                                                                  (Date)
                                                                           Part III
                        NOTICE OF REVOCATION OF NONRESIDENT INCOME TAX AGREEMENT
                                        WARNING: COMPLETE ONLY IF REVOKING AGREEMENT
Notice is hereby given that the West Virginia Nonresident Income Tax Agreement (Form WV/NRW-4) previously executed by or on behalf of the 
above-named Nonresident is revoked for taxable years of the above-name Organization (Pass-through entity) that begins after today’s date.
SIGN
HERE
          (Signature of Nonresident Partner, Shareholder, or Beneficiary, or of an Authorized Corporate Officer)

          (Print Named Signed Above)

          (Mailing Address if Different from Above)                                                                                                                  (Date)

Form NRW-4                                        West Virginia State Tax Department                                                                                               Page 1

                       WEST VIRGINIA NONRESIDENT INCOME TAX AGREEMENT

                                                       INSTRUCTIONS

Who May File: Any nonresident individual, corporation, or partnership who has West Virginia source income derived from a 
partnership, S Corporation, estate, trust, or limited liability company (“organization”) who desires to not have West Virginia 
income tax withheld by that organization as provided in West Virginia Code § 11-21-71a, must complete a West Virginia 
Nonresident Income Tax Agreement (Form WV/NRW-4) and timely file it with the organization. A corporation is a nonresident 
if its commercial domicile is located in another state.

When and Where to File: This form must be completed and filed with the organization on or before the last day of the 
organization’s taxable year. If the distributee receives West Virginia source income from more than one such organization, 
a separate form WV/NRW-4 must be filed with each organization in order to avoid withholding by that organization. The 
organization may copy this form or use a facsimile to distribute as follows: (1) one copy to be file with the organization’s 
West Virginia income tax return, (2) one copy to be retained by the pass-through entity, and (3) one copy of the nonresident 
distributee.

West Virginia Income Tax Withholding for Nonresidents: Every Organization distributing West Virginia source income to 
a nonresident distributee is required to withhold West Virginia income tax on the amount thereof distributed to Nonresident 
Distributee unless the nonresident distributree tile files this form the tax return file for the taxable year of its receipt. The 
withholding tax rate is 5.12% of distributions of West Virginia source income (whether actual or deemed distributions). The 
amount of tax withheld and remitted by the organization is allowed as a credit against the distributee’s West Virginia income 
tax liability for that taxable year.

Nonresident Agreement: Once this agreement is executed, it must be filed with the organization to avoid having withholding 
tax deducted from further distributions (actual or deemed). This agreement first applies to the taxable year of the organization 
during which the organization receives a properly executed agreement from the nonresident distributee.

Duration of Agreement: Once this agreement is filed with the organization, it remains in effect until it is revoked by the 
nonresident distributee, or by the Tax Commissioner.

Revocation:

1. A nonresident distributee may revoke this agreement by completing this form and filing it with the organization 
through which it receives source income. Revocation applies prospectively, meaning that it first applies to taxable years of 
the organization which begin after revocation is filed with that organization.

2. The Tax Commissioner may revoke this agreement if the nonresident distributee fails to file a West Virginia income 
tax return (IT-140, PTE-100, or CIT-120) for more than 60 days after the due date of the return (determined by including any 
authorized extensions(s) of time for filing such return, or to timely pay West Virginia income tax for any taxable year covered 
by this agreement.

Form NRW-4                          West Virginia State Tax Department                                Page 2