Form It-141qft - For Resident And Nonresident Qualified Funeral Trusts
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2IT-141QFT
Rev. 02/13/02
WEST VIRGINIA FIDUCIARY INCOME TAX RETURN
For Resident and Nonresident Qualified Funeral Trusts
Calender Year____________
or Fiscal Year Ended ____________________, 19____________
•
Number of QFT's Included
Federal Employer's Identification Number
On This Return
Number of Resident QFT's
Name of Trust:
Number of Nonresident QFT's
Name, Address and Title of Trustee:
Check if Applicable
r
Final Return
r
Amended Return
r
Composite Return
•
1.Federal Taxable Income (enter line 12, Federal Form 1041-QFT; If composite return, see instructions)
1.
2. ADDITIONS
a. Interest Income on State and Municipal bonds, other than West Virginia
2a.
b. Other additions - state nature and source
2b.
•
3.
Total additions (add lines 2a and 2b)
3.
4.
SUBTRACTIONS
a. Interest income on US obligations specifically exempt from State tax
4a.
600.00
b. West Virginia exemption
4b.
c. Other subtractions - state nature and source
4c.
•
5.
Total subtractions (add lines 4a through 4c)
5.
6.
West Virginia taxable income (line 1 plus line 3 minus line 5)
6.
r
r
r
r
•
7.
West Virginia Tax (check one)
Rate Schedule
Schedule NR
Schedule T
Composite
7.
•
8.
Business Credits
8.
•
9.
Credit for income taxes paid to other states
9.
•
10. Previous payments/Payments with extension of time
10.
11
Total credits (Sum of lines 8, 9 and 10)
11.
•
12. If line 7 is greater than line 11, enter BALANCE DUE
12.
13. INTEREST for late payment
13.
14. ADDITIONS to tax for late filing and/or late payment
14.
•
15. Total TAX due (Add lines 12 through 14)
15.
•
16. If line 11 is greater than line 7, enter OVERPAYMENT
16.
•
17. Amount to be CREDITED to next year's tax
17.
•
18. Amount to be REFUNDED
18.
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.
(Date)
(Signature of trustee or officer representing trustee)
(Title)
(Signature and title or preparer other than trustee)
(Address)
DO NOT USE THIS SPACE
Mail to:
West Virginia State Tax Department
Internal Auditing Division
P.O. Box 1071
Charleston, West Virginia 25324-1071
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