Form Wv-8453 - Individual Income Tax Declaration For Electronic Filing - 2000
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12000
WV-8453
ST
ST
STA A A A A TE OF
TE OF
TE OF
TE OF WEST
WEST
WEST
WEST VIRGINIA
VIRGINIA
VIRGINIA
VIRGINIA
ST
ST
TE OF
WEST
VIRGINIA
INDIVIDUAL INCOME TAX
(Rev. 9/00)
DECLARATION FOR ELECTRONIC FILING
For The Year January 1 - December 31,
2000
0 0 0 0 0 0 0 0 0 0
1
IRS DCN
IRS DCN
IRS DCN
IRS DCN
IRS DCN
Your first name and initial
Your first name and initial
Your first name and initial
Last name
Last name
Last name
Your Social Security Number
Your Social Security Number
Your Social Security Number
Your first name and initial
Your first name and initial
Last name
Last name
Your Social Security Number
Your Social Security Number
L L L L L
Use
Use
Use
Use
Use
A A A A A
label.
label.
label.
label.
label.
B B B B B
If a joint return, spouse's first name and initial
If a joint return, spouse's first name and initial
If a joint return, spouse's first name and initial
If a joint return, spouse's first name and initial
If a joint return, spouse's first name and initial
Last name, if different
Last name, if different
Last name, if different
Last name, if different
Last name, if different
Spouse's Social Security Number
Spouse's Social Security Number
Spouse's Social Security Number
Spouse's Social Security Number
Spouse's Social Security Number
E E E E E
Otherwise,
Otherwise,
Otherwise,
Otherwise,
Otherwise,
L L L L L
please
please
please
please
please
Home Address (number and street)
Home Address (number and street)
Home Address (number and street)
Home Address (number and street)
Home Address (number and street)
Daytime telephone #
Daytime telephone #
Daytime telephone #
Daytime telephone #
Daytime telephone #
H H H H H
print or
print or
print or
print or
print or
E E E E E
City, town or post office, state and ZIP code
City, town or post office, state and ZIP code
City, town or post office, state and ZIP code
City, town or post office, state and ZIP code
City, town or post office, state and ZIP code
type.
type.
type.
type.
type.
R R R R R
E E E E E
Part I
Tax Return Information (Whole dollars only)
1. 1. 1. 1. 1. Federal adjusted gross income
Federal adjusted gross income
Federal adjusted gross income
Federal adjusted gross income
Federal adjusted gross income
1 1 1 1 1
Check form filed:
Check form filed:
Check form filed:
Form IT-140, line 1;
Form IT-140, line 1;
Form IT-140, line 1;
Form IT-140S, line 1
Form IT-140S, line 1
Form IT-140S, line 1 ......................................................
......................................................
......................................................
......................................................
Check form filed:
Check form filed:
Form IT-140, line 1;
Form IT-140, line 1;
Form IT-140S, line 1
Form IT-140S, line 1
......................................................
2 2 2 2 2
2. 2. 2. 2. 2. WV Income Tax (Form IT-140, line 8; Form IT-140S, line 6)
WV Income Tax (Form IT-140, line 8; Form IT-140S, line 6)
WV Income Tax (Form IT-140, line 8; Form IT-140S, line 6)
WV Income Tax (Form IT-140, line 8; Form IT-140S, line 6)
WV Income Tax (Form IT-140, line 8; Form IT-140S, line 6) ...................................................................
...................................................................
...................................................................
...................................................................
...................................................................
3 3 3 3 3
3. 3. 3. 3. 3. WV Tax Withheld (Form IT-140, line 9; Form IT-140S, line 7)
WV Tax Withheld (Form IT-140, line 9; Form IT-140S, line 7)
WV Tax Withheld (Form IT-140, line 9; Form IT-140S, line 7)
...................................................................
...................................................................
WV Tax Withheld (Form IT-140, line 9; Form IT-140S, line 7)
WV Tax Withheld (Form IT-140, line 9; Form IT-140S, line 7) ...................................................................
...................................................................
...................................................................
4 4 4 4 4
4. 4. 4. 4. 4. Estimated Tax Payments
Estimated Tax Payments
Estimated Tax Payments
Estimated Tax Payments
Estimated Tax Payments
Payments
Payments
Payments
Payments
Payments
Extensions
Extensions
Extensions
Extensions
Extensions
) ) ) ) )
and
and
and
with
with
with
(Form IT-140, line 10; Form IT-140S, line 8
(Form IT-140, line 10; Form IT-140S, line 8
(Form IT-140, line 10; Form IT-140S, line 8
and
and
with
with
(Form IT-140, line 10; Form IT-140S, line 8
(Form IT-140, line 10; Form IT-140S, line 8
S S S S S
5 5 5 5 5
5. 5. 5. 5. 5. Balance Due (Form IT-140, line 16; Form IT-140S, line 10)
Balance Due (Form IT-140, line 16; Form IT-140S, line 10)
Balance Due (Form IT-140, line 16; Form IT-140S, line 10)
Balance Due (Form IT-140, line 16; Form IT-140S, line 10)
Balance Due (Form IT-140, line 16; Form IT-140S, line 10) ........................................................................
........................................................................
........................................................................
........................................................................
........................................................................
T T T T T
6 6 6 6 6
6. 6. 6. 6. 6. Refund (Form IT-140, line 21; Form IT-140S, line 15)
Refund (Form IT-140, line 21; Form IT-140S, line 15)
Refund (Form IT-140, line 21; Form IT-140S, line 15)
................................................................................
................................................................................
Refund (Form IT-140, line 21; Form IT-140S, line 15)
Refund (Form IT-140, line 21; Form IT-140S, line 15) ................................................................................
................................................................................
................................................................................
A A A A A
Part II
Direct Deposit of Refund (See Instructions)
T T T T T
E E E E E
The first two numbers of the RTN must be 01 through 12 or 21 through 32
7. 7. 7. 7. 7.
Routing transit number (RTN)
Routing transit number (RTN)
Routing transit number (RTN)
Routing transit number (RTN)
Routing transit number (RTN)
8. 8. 8. 8. 8.
Depositor account number (DAN)
Depositor account number (DAN)
Depositor account number (DAN)
O O O O O
Depositor account number (DAN)
Depositor account number (DAN)
F F F F F
9. 9. 9. 9. 9.
Type of account:
Type of account:
Type of account:
Type of account:
Type of account:
Savings
Savings
Savings
Savings
Savings
Checking
Checking
Checking
Checking
Checking
Part III
Declaration of Taxpayer
W W W W W
Under penalties of perjury, I declare that I have compared the information contained on my return with the information I have provided to my Electronic Return Originator and that the amounts described in
E E E E E
Part I above agree with the amounts shown on the corresponding lines of my
West Virginia income tax return. To the best of my knowledge and belief, my return is true, correct and complete. I consent
2000
S S S S S
that my return, including this declaration and accompanying schedules and statements, be sent to the West Virginia
. If I have filed a joint federal and state return, I understand
State Tax Department
fully
that, if there is an error on either return, my state return will be rejected. If the processing of my return or refund is delayed, I authorize the
to disclose to my ERO and/or the
authorized
State Tax Department
T T T T T
transmitter the reason(s) for the delay, or when the refund was sent.
Please
Please
Please
Please
Please
Sign Here
Sign Here
Sign Here
Sign Here
Sign Here
Your signature
Your signature
Your signature
Your signature
Your signature
Date
Date
Date
Date
Date
Spouse's signature
Spouse's signature
Spouse's signature
Spouse's signature
Spouse's signature
Date
Date
Date
Date
Date
V V V V V
Part IV
Declaration & Signature of Electronic Return Originator (ERO) & Paid Preparer
I I I I I
I declare that I have reviewed the above taxpayer's return and that entries on Form WV-8453 are complete and correct to the best of my knowledge. (ERO's who are collectors are not responsible for reviewing
R R R R R
the taxpayer's return; however, they must ensure that Form WV-8453 accurately reflects the data on the return.) I have obtained the taxpayer's signature on Form WV-8453 before submitting this return
to the
State Tax Department
, have provided the taxpayer with a copy of all forms and information to be filed with the West Virginia
, and have followed all other
procedures and
State Tax Department
G G G G G
requirements described in the West Virginia Handbook for Electronic Filers of Individual Income Tax Returns (Tax Year
). If I am also the Paid Preparer, under penalty of perjury I declare that I have examined
2000
the above taxpayer's return and accompanying schedules and statements, and to the best of my knowledge and belief they are true, correct, and complete. Declaration of preparer is based on all information
I I I I I
D a t e
D a t e
D a t e
D a t e
D a t e
Check if:
Check if:
Check if:
Check if:
Check if:
Your PTIN/SSN
Your PTIN/SSN
Your PTIN/SSN
Your PTIN/SSN
Your PTIN/SSN
of which preparer has any knowledge.
ERO's
ERO's
ERO's
Paid Preparer
Paid Preparer
ERO's
ERO's
Paid Preparer
Paid Preparer
Paid Preparer
N N N N N
Signature
Signature
Signature
Signature
Signature
Self-Employed
Self-Employed
Self-Employed
Self-Employed
Self-Employed
I I I I I
Firm's name (or
Firm's name (or
Firm's name (or
Firm's name (or
Firm's name (or
Phone #
Phone #
Phone #
Phone #
Phone #
EI No.
EI No.
EI No.
EI No.
EI No.
yours, if self-
yours, if self-
yours, if self-
yours, if self-
yours, if self-
A A A A A
Zip Code
Zip Code
Zip Code
Zip Code
Zip Code
employed) and
employed) and
employed) and
employed) and
employed) and
address
address
address
address
address
ERO's are instructed to retain the WV-8453 and all supporting documents for not less than three (3) years.
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements and to the best of my knowledge and belief, they are true, correct and complete. Declaration
D a t e
D a t e
D a t e
D a t e
D a t e
Check if:
Check if:
Check if:
Check if:
Check if:
Preparer's PTIN/SSN
Preparer's PTIN/SSN
Preparer's PTIN/SSN
Preparer's PTIN/SSN
Preparer's PTIN/SSN
of preparer is based on all information of which preparer has any knowledge.
Preparer's
Preparer's
Preparer's
Preparer's
Preparer's
Self-Employed
Self-Employed
Self-Employed
Self-Employed
Self-Employed
Paid
Paid
Paid
Paid
Paid
Signature
Signature
Signature
Signature
Signature
Preparer's
Preparer's
Preparer's
Preparer's
Preparer's
EI No.
EI No.
Phone #
Phone #
Phone #
Phone #
Phone #
EI No.
EI No.
EI No.
Firm's name
Firm's name
Firm's name
Firm's name
Firm's name
Use
Use
Use
Use
Use
(or yours, if
(or yours, if
(or yours, if
(or yours, if
(or yours, if
Zip Code
Zip Code
Zip Code
Zip Code
Zip Code
self-employed)
self-employed)
self-employed)
self-employed)
self-employed)
Only
Only
Only
Only
Only
and address
and address
and address
and address
and address
DO NOT USE SPACE BELOW
DO NOT USE SPACE BELOW
DO NOT USE SPACE BELOW
DO NOT USE SPACE BELOW
DO NOT USE SPACE BELOW
MUST
NOTE: Part IV of this form
be completed
in full as required. ERO's are required to file and
hold this document and all attachments for three
(3) years from date filed.
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