Form It-140 - West Virginia Resident Income Tax Return 2001
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1
2WEST VIRGINIA RESIDENT INCOME TAX RETURN - 2001
WEST VIRGINIA RESIDENT INCOME TAX RETURN - 2001
IT-140
IT-140
A
First Name and Initial
First Name and Initial
Last Name
Last Name
Your Social Security Number
Your Social Security Number
Spouse's First Name and Initial (if joint return)
Spouse's First Name and Initial (if joint return)
Spouse's Last Name (if different)
Spouse's Last Name (if different)
Spouse's Social Security Number
Spouse's Social Security Number
Present Home Address
Present Home Address
USE
USE
Enter extended due date
Enter extended due date
LABEL,
LABEL,
PRINT
PRINT
City or Town
City or Town
County
County
State
State
Zip Code
Zip Code
MM
MM
DD
DD
YY
YY
OR TYPE
OR TYPE
If you are filing Form WV-8379 as an injured
spouse, check this box............................
Your Year of Birth
Your Year of Birth
Spouse's
Spouse's
Telephone Number
Telephone Number
See page 5 for information.
B
Are the name(s) and address above the same as shown on your 2000 return?................................... YES
Are the name(s) and address above the same as shown on your 2000 return?................................... YES
NO
NO
If “NO” enter the name(s) and address from your 2000 return:________________________________________________________________
If “NO” enter the name(s) and address from your 2000 return:________________________________________________________________
FILING STATUS (CHECK ONE)
FILING STATUS (CHECK ONE)
EXEMPTIONS
EXEMPTIONS
C
D
D
1.
1.
Exemptions claimed on your federal return..................................................
1.
1.
Married filing jointly (even if only one spouse had income),Single,
(SEE INSTRUCTIONS IF YOU MARKED FILING STATUS 2 )
Head of household, or Widow(er) with dependent child...............
Did your spouse die in 1999 or 2000?_____
If yes (AND you
2.
2.
2.
2.
Married filing separately. See instructions on page 25 AND
have not remarried), enter 1 and the year your spouse died____________
give spouse's social security number above and enter
3.
TOTAL EXEMPTIONS (add boxes 1 and 2). Enter here and on line 6
spouse’s full name here:
below. If box 3 is zero, enter $500 on line 6 below..................................
00
00
1
1
1.
1.
FEDERAL ADJUSTED GROSS INCOME
(federal Form 1040, line 33; Form 1040A, line 19; or Form 1040EZ, line 4) ............
00
00
2
2
+
+
2.
2.
ADDITIONS TO INCOME (line 28) of Schedule M:
−
−
00
00
3
3
3.
3.
SUBTRACTIONS FROM INCOME (line 41) of Schedule M:
00
00
4
4
4.
4.
WEST VIRGINIA ADJUSTED GROSS INCOME (line 1 plus line 2 minus line 3). ......................................................
00
00
5
5
5.
5.
LOW-INCOME EARNED INCOME EXCLUSION (from worksheet on page 12). ..........................................................
00
00
6
6
6.
6.
EXEMPTIONS (box 3 of Section D above_______ x $ 2,000) ......................................................................................
00
00
7
7
7.
7.
WEST VIRGINIA TAXABLE INCOME
(line 4 minus lines 5 and 6) IF LESS THAN ZERO, ENTER ZERO ...............................
00
00
8
8
INCOME TAX DUE from (check one):
Tax Tables
Rate Schedule
Schedule T ..............................
8.
8.
00
00
9
9
WEST VIRGINIA INCOME TAX WITHHELD (ATTACH LEGIBLE W-2'S OR 1099'S) .....
9.
9.
00
00
10
10
ESTIMATED TAX PAYMENTS AND PAYMENTS WITH EXTENSION ......................
10.
10.
11
11
00
00
TAX CREDITS/EMPLOYMENT/NONFAMILY ADOPTION CREDITS ..............................
11.
11.
00
00
12
12
CREDIT FOR INCOME TAX PAID TO OTHER STATE(S) (attach Schedule E) ...........
12.
12.
13
13
00
00
SUM OF PAYMENTS AND CREDITS (add lines 9 through 12) ..................................................................................
13.
13.
14
14
00
00
BALANCE OF TAX DUE (line 8 minus line 13) .............................................................................................................
14.
14.
00
00
15
15
PENALTY DUE (from Form IT-210)(SEE INSTRUCTIONS ON PAGE 27) ..................
15.
15.
CHECK IF REQUESTING WAIVER/ANNUALIZED WORKSHEET ATTACHED
1
1
00
00
16.
16.
BALANCE DUE THE STATE (add lines 14 and 15) ....................................................................................................
16
16
00
00
17.
17.
OVERPAYMENT (subtract line 8 from line 13) .............................................................................................................
17
17
18
18
00
00
AMOUNT OF OVERPAYMENT TO BE CREDITED TO 2002 ESTIMATED TAX ...........
18.
18.
19.
19.
WEST VIRGINIA CHILDREN'S TRUST FUND to help prevent child abuse and neglect.
00
00
19
19
Enter the amount of your contribution:
Enter the amount of your contribution:
$2,
$2,
$5,
$5,
$10,
$10,
Other $
Other $
20
20
00
00
20.
20.
DEDUCTIONS FROM YOUR OVERPAYMENT (add lines 18 and 19) ........................................................................
21
21
00
00
2
21.
21.
REFUND DUE YOU (subtract line 20 from line 17) ......................................................................................................
REFUND OF $1 WILL BE ISSUED ONLY IF A WRITTEN REQUEST IS ATTACHED TO THIS RETURN.
Type:
Checking
Savings
Routing Number
Account Number
SIGN HERE
SIGN HERE
– Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements,
– Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements,
and to the best of my knowledge and belief it is true, correct, and complete.
and to the best of my knowledge and belief it is true, correct, and complete.
My/our initials in the boxes indicates waiver of my / our rights of confidentiality for the purpose of contacting the preparer regarding this return.
My/our initials in the boxes indicates waiver of my / our rights of confidentiality for the purpose of contacting the preparer regarding this return.
Your Signature
Date
Spouse's Signature
Spouse's Signature
Date
Date
DO NOT USE SPACE BELOW
DO NOT USE SPACE BELOW
Page 13
Paid Preparer’s Signature
Date
Address of Preparer
Telephone
MAIL TO: West Virginia State Tax Department,
MAIL TO: West Virginia State Tax Department,
P.O. Box 1071, Charleston, WV 25324-1071
P.O. Box 1071, Charleston, WV 25324-1071
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