Form Wv/hcp-3a - West Virginia Annual Return Of Broad Based Health Care Related Taxes 2008
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3WV/HCP-3A
WEST VIRGINIA ANNUAL RETURN OF BROAD
2008
REV 10-07
BASED HEALTH CARE RELATED TAXES
FEIN, NAME AND ADDRESS
PERIOD ENDING
METHOD OF
ACCOUNTING
|
|
FEIN
(CHECK ONE)
MM
DD
YYYY
DUE DATE
ACCRUAL
|
|
MM
DD
YYYY
CASH
EXTENSION DATE
|
|
MM
DD
YYYY
BEFORE COMPLETING - YOU MUST COMPLETE SCHEDULES A THROUGH E
CALCULATION OF TAX:
1
AMOUNT OF TAX DUE FROM SCHEDULE E .........................................
2
COMBINED ANNUAL MEDICAL MALPRACTICE CREDIT FROM
PRIOR YEAR (CARRY FORWARD)...........................................................
TOTAL TAX DUE/CREDIT
3
IF LINE 1 IS GREATER THAN LINE 2, ENTER REMAINING TAX DUE
OTHERWISE ENTER ZERO ON THIS LINE..............................................
4
IF LINE 2 IS GREATER THAN LINE 1, ENTER CREDIT TO BE CARRIED
FORWARD (THIS CREDIT IS NOT REFUNDABLE)..................................
PAYMENTS AND CREDITS
5
TOTAL ESTIMATED PAYMENTS FOR PERIOD
COVERED BY THIS RETURN...............................
6
CREDIT FOR OVERPAYMENT FROM PRIOR
YEAR ANNUAL RETURN.....................................
7
TOTAL PAYMENTS AND CREDITS (ADD LINES 5 AND 6.........................
TAX DUE/OVERPAYMENT
8
TAX DUE (IF LINE 3 IS GREATER THAN LINE 7 ENTER HERE)..............
9
OVERPAYMENT (IF LINE 7 IS GREATER THAN LINE 3 ENTER HERE)..
REFUND/CREDIT
10
AMOUNT OF LINE 9 YOU WANT REFUNDED..........................................
11
AMOUNT OF LINE 9 YOU WANT CREDITED TO TAXABLE
YEAR ENDING ______________.............................................................
MAKE CHECKS PAYABLE TO AND MAIL TO:
WV STATE TAX DEPARTMENT
PO BOX 773
CHARLESTON WV 25323-0773
*H04100701A*
(304) 558-6614 1-800-982-8297
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