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NAME FEIN
9. Adjusted Corporate Net Income Tax from Schedule 1,Schedule 2, or UB-CR........... 9 .00
10. Prior year carryforward credit................................................................... 10 .00
11. Estimated and extension payments......................................................... 11 .00
12. Withholding must match the withholding statements unless withholding
is from NRSR.......................................................................................... 12 .00
CHECK HERE IF WITHHOLDING IS FROM NRSR (NONRESIDENT SALE OF REAL ESTATE)
13. Payments (add lines 10 through 12; must match total on Schedule C) ....................... 13 .00
14. Overpayment previously refunded or credited (amended return only)........................ 14 .00
15. TOTAL PAYMENTS (subtract line 14 from line 13).................................................... 15 .00
16. If line 15 is larger than line 9, enter overpayment ...................................................... 16 .00
17. Amount of line 16 to be credited to next year’s tax.................................................... 17 .00
18. Amount of line 16 to be refunded (subtract line 17 from line 16)............................... 18 .00
19. If line 15 is smaller than line 9, enter tax due here.................................................... 19 .00
20. Interest for late payment (see instructions)................................................................. 20 .00
21. Additions to tax for late filing and/or late payment (see instructions).......................... 21 .00
22. Penalty for underpayment of estimated tax (Form CIT-120U line 6; attach schedule ) 22 .00
23. TOTAL DUE with this return (add lines 19 through 22)............................................. 23 .00
Direct Deposit CHECKING SAVINGS
of Refund
ROUTING NUMBER ACCOUNT NUMBER
INCORRECT ACCOUNT INFORMATION MAY RESULT IN A $15.00 RETURNED PAYMENT CHARGE.
PLEASE SEE PAGE 3 OF INSTRUCTIONS FOR PAYMENT OPTIONS.
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.
Signature of O fficer/Partner or Member Print name of O fficer/Partner or Member Date
Title Email Business Telephone #
Signature of paid preparer Print name of Preparer Date
Firm’s name and address Preparer’s Email Preparer’s Telephone #
MAIL TO: WEST VIRGINIA TAX DIVISION
TAX ACCOUNT ADMINISTRATION
PO BOX 1202
CHARLESTON WV 25324-1202
*B30202202W*
B30202202W
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