State Of West Virginia - West Virginia Department Of Commerce

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STATE OF WEST VIRGINIA
WV-GSR-01
Department of Revenue
(Rev. 05/09)
State Tax Department
RETURN THIS FORM (ALONG WITH THE WV-ARI-001 AUTHORIZATION TO RELEASE
INFORMATION) EITHER BY FAX 304 -558-8643 OR MAIL TO:
Administrative Support Unit
WV State Tax Department
Internal Auditing Division
DATE: ______________
1001 Lee Street East
Charleston, WV 25301
Phone; 304-558-0678, 304-558-8618, 304-558-8695, 304-558-1114
FAX 304-558-8643___
This is to request a Certificate of Good Standing from the West Virginia State Tax Department for:
Tax Identification Number: ___________________________________________________
Complete Business Name: ________________________________________________________
Business Location Address: ____________________________________________________
Mailing Address: ______________________________________________________________
Is the business a Partnership?
________ Yes
________
No
Is the business a Sole Ownership?
_______ Yes
________
No
Is the business a Corporation / LLC?
_______ Yes
________ No
If none of these apply, what type of business Registration do you hold with West Virginia?
_________________________________________________________________________________
If you would like the response to be returned to you by facsimile, please note your fax number here:
( ____ ) ______________________ otherwise - it will be mailed to the address provided.
We do not fax this information to the Secretary of States office or the ABC Commission
I also understand that the secrecy provisions of the West Virginia Tax Procedure and
Administration Act (WV Code §11-10) prevent the Tax Department from disclosing any
information without having a waiver of confidentiality. I am completing the waiver
(form ARI-001) and attaching it to this request.
I also understand that in the event that this business is not in good standing with the Tax
Department I will be notified in writing as to what tax returns or tax payments are considered not
filed or paid and who to contact with any questions regarding that situation.
Signature and Title of Person Requesting the Letter of Good Standing:
Signature: ______________________________________________________________________________
Title:_____________________________ Phone: ____________________________________
Administrative Support Unit ♦ 1001 Lee Street East Charleston WV 25301♦ Fax (304) 558-8643

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