Form Wv/sev-401c - Annual Coal Severance Tax Return Page 4
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4WV/SEV-401C
ANNUAL COAL SEVERANCE TAX RETURN
Page 4 of 4
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SCHEDULE D - SUBSIDIARIES REPORTED
FEIN
NAME
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Under penalties of perjury, I declare that I have examined this return (including accompanying schedules and statements) and to the
best of my knowledge and belief it is true, 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)
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