Form Wv/it-140es - Individual Estimated Income Tax Payment

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STATE OF WEST VIRGINIA
State Tax Department, Tax Account Administration Div
P. O. Box 342
Charleston, WV 25322-0342
Earl Ray Tomblin, Governor
Craig A. Griffith, Tax Commissioner
Name
Address
Account #:
City
State
Zip
WV/IT-140ES
rtL063 v.7-Web
INDIVIDUAL ESTIMATED INCOME TAX PAYMENT
NOTE: This return is for your use in filing and paying your individual estimated income tax. To
calculate the amount you should pay, visit out website at https:// and click on the
instruction brochure (FORM IT-140ESI).
Taxable Year End:
Payment Due Date:
Your Social Security Number:
Spouse's Social Security Number:
Part 1: Payment
Amount of This Payment
.
Part 2: Change of Address
Check here and complete the CHANGE OF ADDRESS if any information preprinted on this form is incorrect or changed:
Name(s):
Mailing Address:
City:
State and Zip Code:
MAKE CHECK PAYABLE AND MAIL TO: WEST VIRGINIA STATE TAX DEPARTMENT
TAX ACCOUNT ADMINISTRATION DIVISION
PO BOX 342, CHARLESTON, WV 25322-0342
FOR ASSISTANCE CALL
(304) 558-3333
TOLL FREE WITHIN WV
(800) 982-8297
For more information visit our web site at:
File online at: https://mytaxes.wvtax.gov
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