Raffle Boards And Games Quarterly Return
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1
2STATE OF WEST VIRGINIA
State Tax Department, Charitable Bingo/Raffle Unit
P.O. Box 1143
Charleston, WV 25324-1143
Craig A. Griffith, Tax Commissioner
Earl Ray Tomblin, Governor
Name
Address
Account #:
City
State
Zip
WV/RAFBRD-3
RAFFLE BOARDS AND GAMES QUARTERLY RETURN
rtL182 v.4-web
NOTE: This return has been redesigned. To avoid delays in the processing of this return, DO NOT use any older
forms you may have. For information regarding the State Tax Department’s new computer system, visit our
website at
Filing Period:
to
Due Date:
THIS FORM MUST BE COMPLETED AND RETURNED EVEN THOUGH NO FEES ARE DUE
SECTION 1 - FEE CALCULATION
1.
Total Sales of Raffle Boards and Games to Retailers in West Virginia for this Quarter
.
2.
Rate
0.20
3.
Fee Due (Multiply Line 1 by Line 2)
.
4.
Non-Waivable Interest
.
5.
Additions to Tax
.
6.
Total Tax Due (Add Lines 3, 4 and 5)
.
FOR ASSISTANCE, CALL THE BINGO AND RAFFLE UNIT AT (304) 558-8510
SECTION 2 - CERTIFICATION TO REPORT
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, and complete.
(Signature of Taxpayer)
(Name of Taxpayer - Type or Print)
(Title)
(Date)
(Person to Contact Concerning this Return)
(Telephone Number)
(Email Address)
(Signature of preparer other than taxpayer)
(Address)
(Date)
PLEASE SEE INSTRUCTIONS ON REVERSE SIDE OF RETURN
MAIL TO: WEST VIRGINIA STATE TAX DEPARTMENT
Charitable Bingo/Raffle Unit
P.O. Box 1143, Charleston, WV 25324-1143
FOR ASSISTANCE CALL (304) 558-8510
For more information visit our web site at:
O
1
3
0
8
0
9
0
1
W
File online at https://mytaxes.wvtax.gov
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