Form Wv/it-101q - West Virginia Employer'S Quarterly Return Of Income Tax Withheld

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STATE OF WEST VIRGINIA
State Tax Department, Tax Account Administration Div
P. O. Box 1667
Charleston, WV 25326-1667
Name
Address
Account #:
City
State
Zip
WEST VIRGINIA EMPLOYER'S QUARTERLY RETURN OF INCOME TAX WITHHELD
WV/IT-101Q
Taxpayers required to file electronically will no longer receive returns for the tax types
rtL049 v 9-Web
subject to the mandatory requirement by mail. Please visit for additional
information.
See instructions on reverse side before completing
Quarter Ending:
Due Date:
AMENDED
this form. Please type or print within the boxes.
Part 1: Complete Lines 1-10
1.
Number of employees who received wages, tips and other compensation for the quarter
2.
Wages, tips and other compensation for the quarter
.
3.
Total WV income tax withheld from wages, tips and other compensation for the quarter
.
Total WV Liability for
WV ________ Liability
4.
5.
WV ________ Liability
6.
WV ________ Liability
7.
Quarter (Must Equal Line 3)
.
.
.
.
8.
Total payments for the quarter
.
9.
Balance due
(If line 7 is greater than line 8, enter difference here)
.
10.
Overpayment (If line 8 is greater than line 7, enter difference here)
Refund
.
Part 2: Tell us about your business. If not applicable to your business, leave blank.
If your business has stopped paying wages, check here
and enter final date you paid wages
M
M
D
D
Y
Y
Y
Y
Part 3: Sign your return.
Under penalties of perjury, I declare that I have examined this return, accompanying schedules and statements, and to the best of my knowledge
and belief, it is true, correct and complete.
(Signature of Taxpayer)
(Name of Taxpayer - Type or Print)
(Title)
(Date)
(Person to Contact Concerning this Return)
(Telephone Number)
(Signature of Preparer other than Taxpayer)
(Address)
(Date)
MAIL TO: WEST VIRGINIA STATE TAX DEPARTMENT
Tax Account Administration Div
P. O. Box 1667, Charleston, WV 25326-1667
FOR ASSISTANCE CALL (304) 558-3333 TOLL FREE (800) 982-8297
For more information visit our web site at:
P
4
3
2
0
1
0
0
1
W
File online at https://mytaxes.wvtax.gov

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