Form It-140nr/py - West Virginia Nonresident/part-Year Resident Income Tax Return - 2002
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1
2
3WEST VIRGINIA NONRESIDENT/PART-YEAR RESIDENT INCOME TAX RETURN - 2002
IT-140NR/PY
C
Your Social Security Number
First Name and Initial
Last Name
Spouse's First Name and Initial (if joint return)
Spouse's Last Name (if different)
Spouse's Social Security Number
Present Home Address
USE
Enter extended due date
LABEL,
PRINT
City or Town
County
State
Zip Code
MM
DD
YY
OR TYPE
If you are filing Form WV-8379 as an
injured spouse, check this box ...........
Your Year of Birth
Spouse's
Telephone Number
I
II
FILING STATUS (CHECK ONE)
EXEMPTIONS
1.
Married filing jointly (even if only one spouse had income),Single,
Exemptions claimed on your federal return ...........................................
1.
2.
Additional exemption if surviving spouse (see page 4).
Head of household, or Widow(er) with dependent child........
Year spouse died ____________
Married filing separately. See Instructions on page 4 AND
2.
TOTAL EXEMPTIONS (add boxes 1 and 2).
3.
give spouse's social security number above and enter spouse’s
Enter here and on line 7 below ..............................................................
full name here ______________________________
00
1
TOTAL WEST VIRGINIA INCOME (from line 50 of Schedule A) ..................................................................................
1.
00
2
FEDERAL ADJUSTED GROSS INCOME (from line 47, Column A of Schedule A) .....................................................
2.
+
00
3
ADDITIONS TO INCOME from line 57 of Schedule M _____________________________________________
3.
−
00
4
SUBTRACTIONS FROM INCOME from line 70 of Schedule M ______________________________________
4.
00
5
MODIFIED ADJUSTED GROSS INCOME (line 2 plus line 3 minus line 4) ..................................................................
5.
00
6
6.
LOW-INCOME EARNED INCOME EXCLUSION (see instructions) ..............................................................................
00
7
7.
EXEMPTIONS (line 3 of Section II above
x $2,000) ......................................................................................
00
8
8.
WEST VIRGINIA TAXABLE INCOME (line 5 minus lines 6 and 7)
..................................
IF LESS THAN ZERO, ENTER ZERO
00
9
9.
TENTATIVE TAX (check here
if Schedule T was used to calculate your tax) ......................................................
10.
INCOME PERCENTAGE (see page 9 for additional instructions)
10
Divide line 1 by line 2 and round the result to four places ...............................................
00
11.
WEST VIRGINIA INCOME TAX (multiply line 9 by line 10) ...........................................................................................
11
00
12
12.
WEST VIRGINIA INCOME TAX WITHHELD .................................................................
YOU MUST ENCLOSE LEGIBLE W-2'S OR 1099'S TO SUPPORT THIS AMOUNT.
13
00
13.
ESTIMATED TAX PAYMENTS AND PAYMENTS WITH EXTENSION ......................
14
00
14.
TAX CREDITS/EMPLOYMENT/NONFAMILY ADOPTION CREDITS ..........................
15
00
15.
CREDIT FOR INCOME TAX PAID OTHER STATE(S) (attach Schedule E) .................
00
16
16.
SUM OF PAYMENTS AND CREDITS (add lines 12 through 15) .................................................................................
BALANCE OF TAX DUE
00
(line 11 minus line 16) ......................................................................................................
17.
17
PENALTY DUE
00
18
(from Form IT-210) (see instructions) ................................................
18.
CHECK IF REQUESTING WAIVER/ANNUALIZED WORKSHEET ATTACHED
1
00
19
BALANCE DUE
THE STATE
19.
(add lines 17 and 18) .....................................................................................................
CHECK HERE
IF PAYMENT BY CREDIT/DEBIT CARD (see instructions)
00
20
OVERPAYMENT
20.
(subtract line 11 from line 16) .........................................................
00
21
21.
AMOUNT OF OVERPAYMENT TO BE CREDITED TO 2003 ESTIMATED TAX .............
22.
WEST VIRGINIA CHILDREN'S TRUST FUND to help prevent child abuse and neglect.
00
22
Enter the amount of your contribution ................................................................................
23
00
23.
DEDUCTIONS FROM YOUR OVERPAYMENT (add lines 21 and 22) ........................................................................
24
00
REFUND
2
24.
DUE YOU (subtract line 23 from line 20) ...................................................................................................
REFUND OF $2 OR LESS WILL BE ISSUED ONLY IF A WRITTEN REQUEST IS ATTACHED TO THIS RETURN.
Type: Checking
Savings
HAVE IT
Routing number
DIRECTLY
Account Number
DEPOSITED
SIGN HERE
–
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, correct, and complete.
I authorize the State Tax Department to discuss my return with my preparer.
Yes
No
Date
Spouse's Signature
Date
Your Signature
DO NOT USE SPACE BELOW
Paid Preparer’s Signature
Date
MAIL TO: West Virginia State Tax Department,
P.O. Box 1071, Charleston, WV 25324-1071
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