Form It-141 - West Virginia Fiduciary Income Tax Return (For Resident And Non-Resident Estates And Trusts) - 2011 Page 2
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10Estate or Trust Name:
FEIN:
SCHEDULE A - BENEFICIARY INFORMATION AND NON-RESIDENT TAX PAID FOR WITHHOLDING
ATTACH ADDITIONAL COPIES OF SCHEDULE AS NEEDED
NAME AND ADDRESS OF EACH BENEFICIARY
NAME
STREET OR OTHER MAILING ADDRESS
CITY
STATE
ZIP CODE
1.
2.
3.
4.
5.
COMPUTATION OF WEST VIRGINIA NON-RESIDENT BENEFICIARIES TAX
(A)
WEST VIRGINIA FILING
(G)
(E)
(F)
(H)
METHOD
IF NRW-4
BENEFICIARY
TAX PAID FOR
SOCIAL
PREVIOUSLY
SHARE OF WV
BENEFICIARIES
(B)
(C)
(D)
SECURITY #
RATE
FILED
INCOME
WITHHOLDING
RESIDENT
COMPOSITE
NONRES
1.
6.5%
2.
6.5%
3.
6.5%
4.
6.5%
5.
6.5%
6. TOTALS
6.5%
SCHEDULE B - WEST VIRGINIA FIDUCIARY MODIFICATIONS
COLUMN I
COLUMN II
ADDITIONS:
TOTAL
AMOUNT ALLOCATED
1.
Interest income on state and municipal bonds, other than West Virginia
2.
Lump sum distribution (federal form 4972)
If this is a
3.
Federal exemption (form 1041, line 20)
Simple
Other additions - state nature and source ___________________________
4.
Trust
5.
Electing small business trusts additions
having
6.
Total additions (add lines 1 through 5, col. II enter here and on page 1, line 2)
NO
Taxable
SUBTRACTIONS:
Income,
7.
Interest income on US obligations specifically exempt from state tax
OMIT
8.
West Virginia exemption
600.00
600.00
Col. II
9.
Other subtractions - state nature and source _________________________
Electing small business trusts subtractions
10
11.
Total subtractions (add lines 7 through 10, col. II enter here and on page 1, line 3)
12.
Net fiduciary modifications (line 6 minus line 11)
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 and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
(Signature of Fiduciary or Officer Representing Fiduciary)
(Date)
Paid
Preparer's
(Signature of Preparer)
(Date)
Use Only
(Firm's Name)
(Address & ZIP Code)
(Telephone Number)
P
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