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Form Wv/it-105 - Specifications For Filing W-2 Forms On Electronic Media - State Of West Virginia Page 4

WV/IT-105

Rev 10/2009

West Virginia State Tax Department

W-2 Transmitter Summary Report

Tax Year _________

Transmitter Name

FEIN

Address

Contact Person

City, State, Zip

Phone # and Extension

EFW2 Format (512 bytes only)

Data:

W-2

Media:

CD Rom

Computer Manufacturer and Model used to create report _____________________

List all employers included in this filing (attach additional sheets if needed)

Employer Name

FEIN

# of W-2s

* File name must be w2report or w2report.zip. Any other file name will be rejected and returned.

Note: Please complete a separate Media Transmitter Report for each CD ROM. Package CD ROMs

appropriately to ensure against damage during shipping. Mail all completed reports along with Form

WV/IT-103 Annual Reconciliation and media to:

Mailing Address:

Courier or Overnight Deliveries (ONLY):

West Virginia State Tax Department

IAD/ Withholding

Revenue Center / Withholding

PO Box 3943

1001 Lee Street East

Charleston, WV 25339-3943

Charleston, WV 25301-1725

Form Wv/it-105 - Specifications For Filing W-2 Forms On Electronic Media - State Of West Virginia Page 4