Form Wv-1096 - Annual Summary And Transmittal Of W-2g Backup Withholding On Certain Gambling Winnings
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1STATE OF WEST VIRGINIA
State Tax Department, Tax Account Administration Div
P. O. Box 3943
Charleston, WV 25326-3943
Name
Address
Account #:
City
State
Zip
ANNUAL SUMMARY AND TRANSMITTAL OF
WV-1096
rtL054 v 3-Web
W-2G BACKUP WITHHOLDING ON CERTAIN GAMBLING WINNINGS
TO BE FILED ON OR
Period Ending
BEFORE FEBRUARY 28
Name of person to contact
Telephone Number
Fax Number
Email Address
1. Federal employer Id
2. Total number of
3. Total withheld as shown
4. Total backup withholding
number (FEIN)
W-2G's
on W-2G
payments this year
.
.
If you owe additional withholding, use WV-945V to pay. If you have an overpayment and want a refund, submit an
amended return(s) for the period(s) of overpayment, use form WV-945 and check the amended box.
Return this entire page to the West Virginia State Tax Department.
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)
(Print Your Name and Title)
(Date)
INSTRUCTIONS
Purpose of Form: Use this form to transmit paper Forms W-2G
to the West Virginia State Tax Department. Do NOT use this form
Line 1: Enter your Federal Employer ID number.
to transmit electronically. For electronic submissions refer to My
Taxes.
Line 2: Enter the total number of W-2G’s submitted
with this transmittal.
Caution: If you are required to file 50 or more of Form W-2G you
must file electronically. If you are required to file electronically
Line 3: Enter total dollar amount withheld as shown
but fail to do so and you do not have an approved waiver you may
on the W-2G’s submitted.
be subject to a penalty.
Line 4: Enter the total of backup withholding payments
Who Must File: The name, address and TIN of the filer on this
made this year.
form must be the same as those you enter in the upper left area for
form W-2G. A filer is a person or entity who files any of these
forms.
MAIL TO: WEST VIRGINIA STATE TAX DEPARTMENT
Tax Account Administration Div
P. O. Box 3943, Charleston, WV 25326-3943
FOR ASSISTANCE CALL (304) 558-3333 TOLL FREE (800) 982-8297
For more information visit our web site at:
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File online at https://mytaxes.wvtax.gov
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