It-140 - West Virginia Personal Income Tax Return - 2015 Page 2
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1
2PRIMARY LAST NAME
SOCIAL
SHOWN ON FORM
SECURITY
IT-140
NUMBER
10
.00
10. Total Taxes Due (from previous page)..............................................................................
11. West Virginia Income Tax Withheld (SEE INSTRUCTIONS)
CHECK HERE IF WITHHOLDING IS FROM NRSR
11
.00
(NON RESIDENT SALE OF REAL ESTATE)......................................................................................................................................
12
.00
(VWLPDWHG 7D[ 3D\PHQWV DQG 3D\PHQWV ZLWK 6FKHGXOH /
13
.00
13. Senior Citizen Tax Credit for property tax paid from Schedule SCTC-1...............................................................................................
14
.00
+RPHVWHDG ([FHVV 3URSHUW\ 7D[ &UHGLW IRU SURSHUW\ WD[ SDLG IURP 6FKHGXOH +(37&
15
.00
15. Credits from Tax Credit Recap Schedule (see schedule on page 6) ..................................................................................................
16
.00
16. Amount paid with original return (amended return only) .....................................................................................................................
17
.00
3D\PHQWV DQG &UHGLWV DGG OLQHV WKURXJK
18
.00
18. Overpayment previously refunded or credited (amended return only) ................................................................................................
19
.00
19. Total payments and credits (line 17 minus line 18)..............................................................................................................................
20
.00
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CHECK IF REQUESTING WAIVER/ANNUALIZED WORKSHEET ATTACHED If you owe penalty, enter here
21
.00
21. Subtract line 20 from line 19 and enter total, (if line 20 is larger, subtract 19 from 20 add to line 10 and enter on line 22)
...................
22
.00
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23
.00
23. If line 21 is greater than line 10, subtract line 10 from line 21. This is your income tax overpayment..................................................
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24
.00
to line 25. If this amount is less than line 23, skip to line 26................................................................................................................
25
.00
25. Subtract line 23 from line 24 and add line 22, this is the total balance of tax due.............................................................................
26
.00
26. Subtract line 24 from line 23, this is your total overpayment..............................................................................................................
27
.00
27. Amount of overpayment to be credited to your 2016 estimated tax.....................................................................................................
28. West Virginia Children’s Trust Fund to help prevent child abuse and neglect.
28
.00
Enter the amount of your contribution
$5
$25
$100
Other
$______________
............................................
29
.00
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REFUND
30
.00
30. Refund due you (subtract line 29 from line 26).................................................................................................
3$< 7+,6 $02817
31
.00
31. Total amount due the State (line 25 plus line 28) PAY THIS AMOUNT.......................................................
Direct
Deposit
CHECKING
SAVINGS
of Refund
ROUTING NUMBER
ACCOUNT NUMBER
PLEASE REVIEW YOUR ACCOUNT INFORMATION FOR ACCURACY. PROVIDING INCORRECT ACCOUNT INFORMATION MAY
RESULT IN A $15.00 RETURNED PAYMENT CHARGE.
Under penalties of perjury, I declare that I have examined this return, accompanying schedules and statements, and to the best of my knowledge and
belief, it is true, correct and complete. I authorize the State Tax Department to discuss my return with my preparer.
YES
NO
Your Signature
Date
Spouse’s Signature
Date
Telephone Number
Signature of preparer other than above
Date
Address
Telephone Number
MAIL TO:
REFUND
BALANCE DUE
Preparer: Check here if
WV State Tax Department
WV State Tax Department
client is requesting that
P.O. Box 1071
P.O. Box 3694
Preparer’s EIN
IRUP 127 EH H¿OHG
Charleston, WV 25324-1071
Charleston, WV 25336-3694
Payment Options
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that is provided to you after the submission of your tax return.
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Payment by credit card – Payments may be made using your Visa® Card, Discover® Card, American Express®
Card or MasterCard®. Visit tax.wv.gov.
–2–
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