Form It-103 - Annual Reconciliation printable pdf download

Form It-103 - Annual Reconciliation

IT-103

ANNUAL RECONCILIATION

CALENDAR YEAR

WV State Tax Department

REV 10/12

PO Box 3943

TO BE FILED ON OR BEFORE

Charleston, WV 25339-3943

FEBRUARY 28

WEST VIRGINIA INCOME TAX REPORTED AS WITHHELD DURING THE YEAR

FIRST

THIRD

TOTAL FOR THE YEAR

.00

QUARTER

SECOND

FOURTH

.00 (A)

.00

QUARTER

Number of Withholding tax

ACCOUNT NUMBER_______________________________________

statements (W-2’s/1099’s)

Transmitted

_______________________________________________________________

Total WV Tax Shown

NAME

as withheld by all

(B)

.00

_______________________________________________________________

statements transmitted

ADDRESS

DO NOT SEND PAYMENT WITH THIS FORM

_______________________________________________________________

BLOCK (A) AND (B) DIFFERENCE: ATTACH EXPLANATION. IF

CITY

STATE

ZIP

UNDERPAYMENT, REMIT SEPARATELY. IF OVERPAYMENT SUBMIT

AN AMENDED (IT-101Q) RETURN FOR PERIOD(S) INVOLVED AND

SIGNATURE______________________________DATE______________

CHECK APPROPRIATE BOX TO REQUEST REFUND.

Form It-103 - Annual Reconciliation