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   SCHEDULE 
                    POST-COAL MINE SITE BUSINESS CREDIT                                                         West Virginia 
   PCM-1                                                                                                        State Tax Department
   REV06-2020                   FOR CORPORATE AND PASS THROUGH ENTITIES
                                                        (FOR PERIODS ON OR AFTER JANUARY 1, 2020)
                                        SECTION A: BUSINESS IDENTIFICATION 
1  FEIN                                                                  WV TAX ID
                                                                 TAX PERIOD
2  BEGINNING                                                             ENDING
                 MM             DD                      YYYY                                    MM    DD                 YYYY
   BUSINESS NAME
3
   TAXPAYER NAME 
4

   HAS THE ABOVE-NAMED BUSINESS ENTITY BENEFITED FROM OTHER 
7  STATE ECONOMIC DEVELOPMENT PROGRAMS OR INCENTIVES THAT        YES. IF YES, THE BUSINESS IS NOT  NO Number of 
   RESULTED IN A REDUCTION OF THEIR INCOME TAX LIABILITY?           ELIGIBLE FOR THIS CREDIT.         Full-time employees
                                SECTION B: COMPUTATION OF ELIGIBLE INVESTMENT
ITEMIZED LISTING OF INVESTMENTS REQUIRED
                                                                                  A                   B                  C 
                                                                                  COST                RATE      QUALIFIED 
1  INVESTMENT WITH USEFUL LIFE OF AT LEAST 4 YEARS BUT LESS THAN 6 YEARS $                            33.33% $

2  INVESTMENT WITH USEFUL LIFE OF AT LEAST 6 YEARS BUT LESS THAN 8 YEARS $                            66.66% $

3  INVESTMENT WITH USEFUL LIFE OF 8 YEARS OR MORE                        $                         100.00%   $

4  TOTAL QUALIFIED INVESTMENT FOR THIS TAX YEAR                                                              $

5  POTENTIAL POST-COAL MINE SITE BUSINESS CREDIT (50% OF LINE 4)                                             $

6  PRIOR PERIOD UNUSED CREDIT (MUST COMPLETE SECTION D)                                                      $

7  TOTAL AVAILABLE POST-COAL MINE SITE CREDIT                                                                $
                                              SECTION C: APPLICATION OF CREDIT
8  CORPORATE NET INCOME TAX                                                                                  $

9  OFFSET LIMIT (50% OF LINE 8)                                                                              $

10 POST-COAL MINE SITE CREDIT CLAIMED AGAINST CORPORATE INCOME TAX                                           $
   (OFFSET MUST BE EQUAL TO OR LESS THAN THE SMALLER OF LINE 7 OR 9)
11 REMAINING CREDIT (LINE 10 SUBTRACTED FROM LINE 7)                                                         $

12 TOTAL QUALIFIED PERSONAL INCOME TAX                                                                       $

13 ENTER AMOUNT OF CREDIT CLAIMED AGAINST PERSONAL INCOME TAX (MUST COMPLETE SECTION E)                      $

14 Total Credit claimed or allocated this year          (Sum of Lines 10 and 13)                             $

15 REMAINING CREDIT (LINE 14 SUBTRACTED FROM LINE 7)                                                         $
                                                                 SIGNATURE
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.

             SIGNATURE OF TAXPAYER                             NAME OF TAXPAYER (PRINT OR TYPE)          TITLE  DATE

   SIGNATURE OF PREPARPER OTHER THAN TAXPATER                                     ADDRESS                       DATE

                    PERSON TO CONTACT CONCERNING THIS RETURN                                                   TELEPHONE

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SCHEDULE PCM-1 (continued) 

                            SECTION D: CREDIT CARRYOVER RECAP
YEAR OF CREDIT ORIGINAL AMOUNT OF CREDIT AMOUNT USED PRIOR PERIODS AMOUNT USED THIS YEAR  REMAINING CREDIT

               SECTION E: POST-COAL MINE SITE CREDIT ALLOCATED TO OTHERS
OWNER NAME                                       OWNER FEIN                   OWNERSHIP % WV/PCM CREDIT  ALLOCATED

                                         INVESTMENT LISTING
                                         (USE ADDITIONAL SHEETS IF NECESSARY) 
NAME OR DESCRIPTION OF ITEM              PURPOSE      DATE ACQUIRED/          USEFUL      NET COST
(LIST SEPARATELY)                                     PLACED IN SERVICE       LIFE

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