Form Wv/nrae - Application For Certificate Of Full Or Partial Exemption Form - West Virginia State Tax Department
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4WV/NRAE
West Virginia
ApplicAtioN foR cERtificAtE of
State Tax
full oR pARtiAl ExEmptioN
Rev. 05/14
Department
Mail completed form to: WV State Tax Department, TAAD/Withholding, PO Box 784, Charleston, WV 25323-0784
Tax Year
Tax Year
Beginning
Ending
MM
DD
YYYY
MM
DD
YYYY
This form is to be used only to request a Certificate of Full or Partial Exemption from the withholding requirements on the proceeds of the sale or
exchange of real property and associated tangible personal property in West Virginia by nonresident individuals and nonresident entities. This form
must be rECEiVEd by the WV State Tax department, Tax Account Administration division no later than 21 days before the closing date.
For multiple tranFeror/sellers complete a separate Form WV/nrae for each one receiving proceeds.
tRANsfERoR/sEllERs iNfoRmAtioN
Name (If joint, give first names and initials of both)
LaST Name (Give spouse’s last name, if different)
YouR SociaL SecuRiTY NumbeR
Name (Corporation, Partnership, Trust, Estate, etc.)
SPouSE’S SoCiAl SECuriTy numbEr
coRpoRaTe officeR, paRTNeR TRuSTee, execuToR oR aDmiNiSTRaToR
FEdErAl EmPloyEr id numbEr
aDDReSS (Number and street)
ciTY, STaTe aND zip coDe (province, postal code and country)
Ownership Percentage
Transferor/Seller’s Entity Type
Individual
corporation
S corporation
Partnership
Limited Liability Company
Limited Liability Partnership
business Trust
estate
Trust
Other _____________________
pRopERty iNfoRmAtioN
DeScRipTioN of pRopeRTY (Include address, or county, district, partial or sub-partial if no
DaTe of cLoSiNg
address is available)
MM
DD
YYYY
coNTRacT SaLeS pRice
●
pRopeRTY accouNT iD NumbeR
transferor/seller’s Adjusted Basis:
Transferor/Seller acquired property by:
●
1031 Exchange
Foreclosure/Repossession
Purchase
Purchase price..................
Add: capital improvements
gift
●
Inheritance
Other _________________________
and settlement costs
●
Use of property at time of sale:
Less: depreciation (if any)
Rental/
Secondary/
Vacant
Other _____________
●
Commercial
Vacation
Land
Adjusted basis...................
tRANsfEREE/BuyER’s iNfoRmAtioN
NAME (If joint, give first names and initials of both)
LAST NAME (Give spouse’s last name, if different)
coRpoRaTe officeR, paRTNeR, TRuSTee, execuToR oR aDmiNiSTRaToR
aDDReSS (Number and Street)
ciTY, STaTe aND zip coDe (province, postal code and country)
Transferee/Buyer’s Entity Type
individual
Partnership
Business Trust
Trust
Corporation
limited liability Company
Estate
S Corporation
limited liability Partnership
other _______________________
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