Form Wv/it-101a - West Virginia Employer'S Annual 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 ANNUAL RETURN OF INCOME TAX WITHHELD
WV/IT-101A
rtL048 v 4-Web
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.
This form is not to be used for an annual reconciliation or Quarterly filers.
See instructions on reverse side before completing this form. Please type or print within the boxes.
AMENDED
Tax Year Ending:
Due Date:
Part 1: Complete Lines 1-6
1. Number of employees who received wages, tips and other compensation for the tax year
2. Wages, tips and other compensation for the tax year
.
3. Total WV income tax withheld from wages, tips and other compensation for the tax year
.
4. Total payments for the tax year
.
5. Balance due (If line 3 is greater than line 4, write difference here)
.
6. Overpayment (If line 4 is greater than line 3, write 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
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4 2
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0
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1
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File online at https://mytaxes.wvtax.gov

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