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Form Wv/bot-301e - 2004 West Virginia Annual Business & Occupation Tax Return Electric Power Businesses Page 3

WV/BOT-301E

(REV 11/04)

PAGE -3-

ELECTRIC POWER BUSINESSES

NAME___________________________________________________________________

IDENTIFICATION NUMBER__________________________________________________

PERIOD:____________________

EXCLUSIONS (SPECIFY IN KILOWATT HOURS)*

SCHEDULE IN WHICH

AMOUNT OF EXCLUSION(S)

DESCRIPTION

CLAIMED

*There is no exclusion for company use or line loss. Enter on Page 2, Schedule A, Column 2.

Please answer all questions:

If you purchased this business in the past twelve (12) months, give the previous owner’s full name and address:

___________________________________________________________________________________________________

During the period covered by this return, did you:

a. Quit business? __________ Sell or otherwise dispose of your business? __________ Exact Date _____________

b. If business was sold, give exact name and address of new owner ______________________________________

_____________________________________________________________________________________________

Address where your records are located _____________________________________________________________

Principal place of business in West Virginia ___________________________________________________________

Nature of business conducted (Describe in Detail) _____________________________________________________

Give name and account number of any additional business(es) operated in West Virginia by the reporting taxpayer

_______________________________________________________________________________________________

Under penalties of perjury, I declare that I have examined this return (including accompanying schedules and statement(s) and

to the best of my knowledge and belief it is true, and complete.

(Name of Taxpayer-Type or Print)

(Title)

(Date)

(Signature of Taxpayer)

(Person to Contact Concerning this Return)

(Telephone Number)

(Signature of prepareer other than Taxpayer)

(Address)

(Date)

Form Wv/bot-301e - 2004 West Virginia Annual Business & Occupation Tax Return Electric Power Businesses Page 3