STATE OF WEST VIRGINIA
State Tax Department, Tax Account Administration Div
P.O. Box 425
Charleston, WV 25322-0425
Name
Address
Account #:
City
State
Zip
WEST VIRGINIA COAL MINING ASSESSMENT AND SPECIAL 2 CENT PER TON TAX
WV/CSR-1
rtL043 v 7-Web
This form must be completed and returned even though no business may have been transacted. If your business was sold
or discontinued, please indicate the exact date and the new owner on the back of this form. If you processs coal only or for
some other reason are not subject to this tax, please write the reason you are not subject to the tax on the back of this form and
return to this office.
Taxpayers required to file electronically will no longer receive returns for the tax types subject to the mandatory
requirement by mail. Please visit for additional information.
MAIL TO: WEST VIRGINIA STATE TAX DEPARTMENT
Tax Account Administration Div
P.O. Box 425, Charleston, WV 25322-0425
FOR ASSISTANCE CALL (304) 558-3333 TOLL FREE (800) 982-8297
For more information visit our web site at:
File online at https://mytaxes.wvtax.gov
See back of return for instructions and information.
PLEASE CUT HERE USE BLUE OR BLACK INK TO COMPLETE VOUCHER DO NOT WRITE IN BARCODE AREA
WV/CSR-1
rtL043 v 7-Web
WEST VIRGINIA COAL MINING ASSESSMENT
AND SPECIAL 2 CENT PER TON TAX
Account ID #
Period Ending:
Date Due:
COAL
TOTAL WHOLE TONS
RATE
TAX DUE (MULTIPLY TONS BY RATE)
.
.
1.
TOTAL CLEAN COAL MINED
00
0.279
.
.
2.
TOTAL CLEAN COAL SOLD
00
0.02
3.
INTEREST
.
.
4.
ADDITIONS TO TAX
.
5.
TOTAL TAX DUE (Add Line 1 Thru Line 4)
Name
Address
City
State
Zip
SIGNATURE
DATE