STATE OF WEST VIRGINIA
State Tax Department, Tax Account Administration Div
P.O. Box 425
Charleston, WV 25322-0425
Name
Address
Account #:
City
State
Zip
WV/SEV-401C
ANNUAL COAL SEVERANCE TAX RETURN
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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.
Period Ending:
Due Date:
Extension Date:
M
M
D
D
Y
Y
Y
Y
Mark FINAL only if you are NO LONGER REQUIRED TO FILE
Check if:
CONSOLIDATED
SEPERATE
FINAL
AMENDED
SCHEDULE E - REPORT OF COAL PRODUCTION FOR TAXABLE YEAR (County Schedule on Page 2)
Name of
County
12th Month Coal Production
Full Year Coal Production
(ROUND TO THE NEAREST WHOLE TON)
(ROUND TO THE NEAREST WHOLE TON)
County of Production
FIPS Code
00
00
.
.
.
00
.
00
00
00
.
.
00
00
.
.
.
00
.
00
00
00
.
.
00
00
.
.
00
00
.
.
.
00
.
00
SCHEDULE A - TAX COMPUTATIONS FULL YEAR
.
1.
Total Tax Due (From Line 10 of Schedule B2)
2.
Total Credits (From Line 8 of Schedule TC)
.
3.
Net Severance Tax Payable (Line 1 minus Line 2)
.
4.
Net Minimum Tax (From Line 7 of Schedule C)
.
5.
Net Amount of Tax (Add Lines 3 and 4)
.
6.
Total Payments Made for the Period Covered by this Return
.
B
7.
Balance of Tax Due (Line 5 minus Line 6) If Line 6 is greater than Line 5, enter 0
.
2
7
8.
NON-WAIVABLE INTEREST
.
0
1
9.
ADDITIONS TO TAX
.
0
10.
PENALTY FOR UNDERPAYMENT OF ESTIMATED TAX
.
9
0
11. TOTAL TAX AND LATE FILING CHARGES DUE (Add Lines 7 through 10)
.
1
W
12.
Overpayment Amount (Line 6 minus Line 5) If Line 5 is greater than Line 6, enter 0
.
13.
Amount of Line 12 to be Credited to Next Year's Tax
.
.
14.
Amount of Line 12 to be Refunded (Line 12 minus Line 13)
00001979438087