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WV/IT-104.1

WEST VIRGINIA DEPARTMENT OF TAX AND REVENUE

(1/97)

LOW-INCOME EARNED INCOME EXCLUSION

INSTRUCTIONS

ELECTION OUT-OF-STATE WITHHOLDING

Senate Bill 17, enacted during the 1996 regular session of the West Virginia Legislature, amends the West Virginia personal

income tax law by giving an earned income exclusion to individuals, head of households, and married couples (who file a joint

return), who have federal adjusted gross income of $10,000 or less for the taxable year. (If married and filing separately,

federal adjusted gross income may not exceed $5,000).

Earned income includes wages, salaries, tips, commissions and other employee compensation. Unearned in-

come includes interest, dividends, retirement income in the form of pensions or annuities, and other income that

is not employee compensation.

ELECTION:

A taxpayer who qualifies for this low-income earned income exclusion may elect to have his or her employer

NOT withhold West Virginia income tax by taking this income exclusion into consideration when determining the amount of

West Virginia personal income taxes the employer is required to withhold from the employee’s paycheck. This election is

made by completing the certificate below and giving it to your employer or payroll officer. The completed certificate is

authorization for your employer to stop withholding West Virginia Personal Income Tax from your paycheck.

CAUTION:

When deciding whether to elect out of state income tax withholding, you should keep in mind that if your federal

adjusted gross income for the year exceeds $10,000, the earned income exclusion does not apply, and your state income tax

bill on April 15th could be $240 or more. Events that could result in your federal adjusted gross income exceeding $10,000

even though your annual wages are currently less than $10,000 include: the likelihood of working overtime hours; whether you

have a second job or will take a second job; whether you will receive a pay raise during the year; if married, whether your

spouse works; whether your spouse’s earned income will increase during the year; whether you have unearned income, the

amount of your unearned income and whether that amount will increase during the year.

If you reasonably believe your federal adjusted gross income for the year will be $10,000 or less and you actually receive

federal adjusted gross income that is more than $10,000, you will owe interest on the amount of West Virginia tax that should

have been withheld by your employer.

Should you need further information, you should call the Taxpayer Services Division at (304)558-3333, or, Toll-Free (in West

Virginia and area code 614) at 1-800-982-8297. TDD service for the hearing impaired: 1-800-292-9833.

CUT HERE

WV/IT-104.1

WEST VIRGINIA DEPARTMENT OF TAX AND REVENUE

(1/97)

LOW-INCOME EARNED INCOME EXCLUSION CERTIFICATE

ELECTION TO NOT WITHHOLD STATE INCOME TAX

GIVE THIS CERTIFICATE TO YOUR EMPLOYER

PRINT OR TYPE FULL NAME HERE

SOCIAL SECURITY NUMBER

HOME ADDRESS

CITY OR TOWN

STATE

ZIP CODE

I believe my federal adjusted gross income for the current calendar year will be $10,000 or less ($5,000 or less if married and filing separately). By signing

this certificate, I authorize my employer to not withhold West Virginia income taxes on up to $10,000 of wages and salaries paid to me during the calendar

year, ($5,000 if employee is married and files on a separate return basis).

I certify, under penalties provided by law, that the information and representations set forth herein are true and correct.

Date

Employee Signature