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
ADDITIONAL TAX ON THE SEVERANCE OF NATURAL RESOURCES
WV/SEV-401V
ANNUAL RETURN
rtL130 v 8-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.
Period Ending:
Due Date:
Extension Date:
M
M
D
D
Y
Y
Y
Y
Check if:
CONSOLIDATED
SEPARATE
FINAL
AMENDED
RESOURCE
TAXABLE AMOUNT
RATE
TAX DUE
1.
COAL - Tons for the Year
00
.
0.56
.
2.
NATURAL GAS - mcf for the Year
.
00
.
0.047
3.
COALBED METHANE - mcf for the Year
00
.
0.047
.
4.
TIMBER - Gross $ for the Year
.
0.0278
.
5.
Total Tax (Add lines 1 through 4)
.
6.
Payments for the Period Covered by this Return and any Credit from Prior Years (Attach Credit Letter)
.
7.
Balance of Tax Due (Line 5 minus Line 6) If Line 6 is greater than Line 5, enter 0 and skip to line 12
.
8.
NON-WAIVABLE INTEREST
.
9.
ADDITIONS TO TAX
.
10.
PENALTY FOR UNDERPAYMENT OF ESTIMATED TAX
.
11.
TOTAL TAX AND LATE FILING CHARGES DUE (Add Lines 7 through 10)
.
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)
.
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)
MAIL TO: WEST VIRGINIA STATE TAX DEPARTMENT
Tax Account Administration Div
P.O. Box 425, Charleston, WV 25322-0425
FOR ASSISTANCE CALL (304) 558-3333 TOLL FREE (800) 982-8297
For more information visit our web site at:
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4
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File online at https://mytaxes.wvtax.gov