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WV/NRAE

INSTRUCTIONS FOR APPLICATION FOR CERTIFICATE FOR FULL OR PARTIAL EXEMPTION

costs such as commissions and state transfer taxes), and subtracting

GENERAL INSTRUCTIONS

depreciation, if applicable.

Purpose of Form

Transferee/Buyer’s information

Use this form to apply for a Certificate of Full or Partial Exemption

from the withholding requirements on the proceeds of the sale

Enter name and address.

of real and associated tangible personal property in WV by

Check box indicating the transferee/buyer’s entity type.

nonresident individuals and nonresident entities. A nonresident

Attach schedule if there are multiple transferees/buyers.

entity is defined to mean an entity that:

Reason for Full or Partial Exemption from

(1) is not formed under the laws of WV; and

(2) is not qualified by or registered with the WV State Tax

Withholding

Department to do business in WV.

Check applicable box(es) in the “Reason for Exemption” column

that reflect the reason(s) for request of a full or partial exemption

Who may file an application

from the income tax withholding requirement.

An individual, fiduciary, corporation, S corporation, limited

liability company, or partnership transferor/seller may file Form

Indicate the amount that you are claiming as subject to tax and

WV/NRAE. A separate Form WV/NRAE is required for each

upon which the income tax withholding should be calculated in

transferor/seller unless the transferor/seller are a husband and wife

the “Amount of Total Payment Subject to Tax” column.

filing a joint WV Income Tax return.

Specific line instructions for Reason for Full or

IMPORTANT: The completed Form WV/NRAE must be

Partial Exemption

received by the WV State Tax Department no later than 21 days

LINE 1 Transfer is to a corporation controlled by the transferor.

before the closing date of the sale or transfer to ensure timely

Required documentation: Copy of the agreement of sale; Certificate

receipt of the Certificate of Full or Partial Exemption.

of Good standing of transferee issued by the state in which

SPECIFIC INSTRUCTIONS

transferee is incorporated; notarized affidavit executed on behalf of

Enter tax year of the transferor/seller if other than a calendar year.

transferee by its President and Treasurer stating that immediately

after the exchange the transferor(s) will own stock in the transferee

Transferor/Seller’s information

possessing at least eighty percent (80%) of the total combined

Enter name, address and indentification number (social secuity

voting power of all classes of transferee’s stock entitled to vote and

or federal employer identification number) of the transferor/seller

at least eighty percent (80%) of the total number of shares of all

applying for the exemption. If the transferor/seller was issued an

other classes of stock of the transfer; and an appraisal establishing

individual taxpayer identification number (ITIN) by the IRS, enter

the fair market value, at the time of exchange, of any property other

the ITIN.

than stock in the transferee which is part of the consideration for

Check the box indicating the transferor/seller’s entity type.

the exchange. Fair market value of any such other property and/

or any money which is part of the consideration for the exchange

Enter transferor/seller’s ownership percentage of the property.

must be stated on the application as the taxable amount.

Property information

LINE 2 Transfer is pursuant to a tax-free reorganization.

Enter description of the property, including street address(es) as

Required documentation: Copy of agreement governing transfer

listed with the WV State Tax Department. If the property does

between transferor and transferee; Certificates of Good Standing

not have a street address, provide the full property account ID

number used by the County Assessor to identify the property (legal

of transferor and transferee issued by the state(s) in which

transferor and transferee are incorporated; copy of the plan of

description and I. D. number)

reorganization showing that transferor and transferee are parties

Enter date of closing for the sale or transfer of the property.

to the reorganization, and an appraisal establishing fair market

Enter contract sales price of the property being sold or transferred.

value, at the time of the exchange, of any property other than stock

or securites in the transferee which is part of the consideration

Enter property account ID number. If the property is made up of

for the exchange and will not be distributed by the transferor in

more than one parcel and has more than one property tax account

pursuance of the plan of reorganization. The fair market value of

number, include all applicable property account ID numbers.

any such other property and/or any money which is part of the

Check box describing the transferor/seller’s acquisition of the

consideration for the exchange and will not be distributed by the

property.

transferor in pursuance of the plan of reorganization must be stated

Check box describing the transferor/seller’s use of the property

on the application as the taxable amount.

at the time of the current sale, and enter the length of time the

LINE 3 Transfer is pursuant to an installment sale.

property has been used for this purpose.

Required documentation: Copy of contract of sale or copy of

Complete the transferor/seller’s Adjusted Basis section by entering

HUD-1 settlement sheet; copy of promissory note to transferor

the purchase price when the transferor/seller acquired the property,

which will be executed by transferee at settlement. That portion

adding the cost of capital improvements (including acquisitions

of the total payment that the transferor receives at or within sixty

Form Wv/nrae - Application For Certificate Of Full Or Partial Exemption Form - West Virginia State Tax Department Page 3

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