Mandate Opt Out Form
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1M
Mandate
Opt Out
t Form
I, ______
__________
___________
_______ hav
ve been prop
perly advised
d of the prefe
erence on th
he
part of th
he State Tax
Department
t to receive a
and process t
tax data in th
he most effic
cient manner
r
possible
and of the L
Legislative r
requirement
to achieve th
this goal. Ho
owever, I do
o hereby elec
ct not
to file my
y 2010 West
t Virginia Pe
ersonal Incom
me Tax retur
urn electronic
cally. I also r
request that
my
election,
by itself, no
ot be the cau
use of any li
ability on th
he part of my
y tax prepar
rer for any fa
ailure
to compl
y with the m
mandate.
________
__________
___________
_____
_______
___________
__________
_____
Signature o
of Taxpayer
Signature
of Preparer
_________
____________
_____________
______
_________
_____________
____________
______
Signature o
of Spouse
Date
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