Fillable IT-140NRS West Virginia Special Nonresident Income Tax Return (State of West Virginia)

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IT-140NRS West Virginia Special Nonresident Income Tax Return (State of West Virginia)

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U.S.A. forms for State of West Virginia

BROWSE STATE OF WEST VIRGINIA (WV) FORMS

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–13–
IT-140NRS
REV. 9-12 F
West Virginia
Special Nonresident Income Tax Return 2012
Last Name Your Social Security Number
If you meet the described conditions, le
this return with the West Virginia State Tax
Department on or before April 15, 2013 for a
refund of West Virginia income taxes withheld
from wages and salaries
First Name MI
Address
Amended
Return (check box)
City State Zip Code
NOTE: Use this form ONLY if you were a resident of Kentucky, Virginia, Pennsylvania, Maryland, or Ohio during the tax year of 2012, West Virginia
source income was from wages and salaries and West Virginia income tax was withheld from such wages and salaries by your employer(s). You must
complete IT-140W to verify West Virginia income tax withheld in order to receive credit. If you were a resident of a state other than Kentucky,
Virginia, Pennsylvania, Maryland, or Ohio, you must check the box Filing as a Nonresident/Part-Year Resident on Form IT-140 to report any income from
West Virginia sources.
If you were a domicilary resident of Pennsylvania or Virginia and spent more than 183 days within West Virginia during 2012, you are also considered a
resident of West Virginia for income tax purposes. Therefore, you are not eligible to le this return and must le Form IT-140 as a resident of West Virginia.
SPECIFIC INSTRUCTIONS ARE ON THE BACK AND PAGE 46
I declare that I was not a resident of West Virginia any time during 2012, I was a resident of the state shown, my only income from sources within West
Virginia was from wages and salaries, and such wages and salaries were subject to income taxation by my state of residence.
YOUR STATE OF RESIDENCE (Check one):
1. Commonwealth of Kentucky
2. State of Maryland
3. State of Ohio
4. Commonwealth of Virginia Number of days spent in West Virginia __________________
5. Commonwealth of Pennsylvania Number of days spent in West Virginia __________________
1. Enter your total West Virginia income from wages and salaries.................................................................. 1 .00
2. Enter total amount of West Virginia Income Tax Withheld from your wages and salaries paid by your
employer in 2012 (Must complete Withholding tax schedule, page 7)........................................................ 2 .00
3. Overpayment previously refunded or credited (Amended Return Only)..................................................... 3 .00
4. West Virginia Children’s Trust Fund to help prevent child abuse and neglect
Enter the amount of your contribution $5 $25 $100 Other $___________.......................... 4 .00
5. Refund Due You (subtract lines 3 and 4 from line 2)
Refund of $2 or less will be issued only if a written request is attached to this form.................................. 5 .00
Direct
Deposit
of Refund
CHECKING SAVINGS
ROUTING NUMBER ACCOUNT NUMBER
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 Telephone Number
Signature of preparer other than above Date Address Daytime Phone Number
Preparer: Check here if
client is requesting that
form NOT be e-led
MAIL TO:
REFUND
WV State Tax Department
P.O. Box 1071
Charleston, WV 25324-1071
BALANCE DUE
WV State Tax Department
P.O. Box 3694
Charleston, WV 25336-3694
Preparer’s EIN
*p40201211F*
Clear Return
Check your return for errors
Print Return
(Web Fill-In Form)
* Indicates Required Field for Filing
*
*
*
Select Below
Click Here for Specific Instructions for This Form
0.00
0.00
Clear >>
0.00
–3– *p40201203A*
IT-140W
REV. 03-12 B West Virginia Withholding Tax Schedule 12
Do NOT send W-2’s, 1099’s, K-1’s and/or WV/NRW-2’s with your return
Enter WV withholding information below.
THIS FORM MUST BE FILED EVEN IS YOU HAVE NO INCOME OR WITHHOLDING
PRIMARY LAST NAME
SHOWN ON FORM
IT-140
SOCIAL
SECURITY
NUMBER
1
A – Employer or Payer Information B – Employee or Taxpayer Information C – WV Tax Withheld
.00
Employer or payer ID from W-2, 1099, K-1, and/or WV/NRW-2 Name
WV WITHHOLDING
Check the appropriate box
Employer or Payer Name Social Security Number
W-2 1099 K-1 WV/NRW-2
Address
.00
Enter State Abbreviation
(from Box #15 on W-2 or Box 11 on 1099)
City, State, ZIP
Income Subject to WV WITHHOLDING
Enter WV withholding Only
2
A – Employer or Payer Information B – Employee or Taxpayer Information C – WV Tax Withheld
.00
Employer or payer ID from W-2, 1099, K-1, and/or WV/NRW-2 Name
WV WITHHOLDING
Check the appropriate box
Employer or Payer Name Social Security Number
W-2 1099 K-1 WV/NRW-2
Address
.00
Enter State Abbreviation
(from Box #15 on W-2 or Box 11 on 1099)
City, State, ZIP
Income Subject to WV WITHHOLDING
Enter WV withholding Only
3
A – Employer or Payer Information B – Employee or Taxpayer Information C – WV Tax Withheld
.00
Employer or payer ID from W-2, 1099, K-1, and/or WV/NRW-2
Name
WV WITHHOLDING
Check the appropriate box
Employer or Payer Name
Social Security Number
W-2 1099 K-1 WV/NRW-2
Address
.00
Enter State Abbreviation
(from Box #15 on W-2 or Box 11 on 1099)
City, State, ZIP
Income Subject to WV WITHHOLDING
Enter WV withholding Only
4
A – Employer or Payer Information B – Employee or Taxpayer Information C – WV Tax Withheld
.00
Employer or payer ID from W-2, 1099, K-1, and/or WV/NRW-2
Name
WV WITHHOLDING
Check the appropriate box
Employer or Payer Name Social Security Number
W-2 1099 K-1 WV/NRW-2
Address
.00
Enter State Abbreviation
(from Box #15 on W-2 or Box 11 on 1099)
City, State, ZIP
Income Subject to WV WITHHOLDING
Enter WV withholding Only
Total WV tax withheld from column C above.................................................... .00
If you have WV withholding on multiple pages, add the totals together and enter the GRAND total on line 11, Form IT-140
0
0
0
0
0
0
0
0
0
Form IT-140NRS.
–3– *p40201203A*
IT-140W
REV. 03-12 B West Virginia Withholding Tax Schedule 12
Do NOT send W-2’s, 1099’s, K-1’s and/or WV/NRW-2’s with your return
Enter WV withholding information below.
THIS FORM MUST BE FILED EVEN IS YOU HAVE NO INCOME OR WITHHOLDING
PRIMARY LAST NAME
SHOWN ON FORM
IT-140
SOCIAL
SECURITY
NUMBER
1
A – Employer or Payer Information B – Employee or Taxpayer Information C – WV Tax Withheld
.00
Employer or payer ID from W-2, 1099, K-1, and/or WV/NRW-2 Name
WV WITHHOLDING
Check the appropriate box
Employer or Payer Name Social Security Number
W-2 1099 K-1 WV/NRW-2
Address
.00
Enter State Abbreviation
(from Box #15 on W-2 or Box 11 on 1099)
City, State, ZIP
Income Subject to WV WITHHOLDING
Enter WV withholding Only
2
A – Employer or Payer Information B – Employee or Taxpayer Information C – WV Tax Withheld
.00
Employer or payer ID from W-2, 1099, K-1, and/or WV/NRW-2 Name
WV WITHHOLDING
Check the appropriate box
Employer or Payer Name Social Security Number
W-2 1099 K-1 WV/NRW-2
Address
.00
Enter State Abbreviation
(from Box #15 on W-2 or Box 11 on 1099)
City, State, ZIP
Income Subject to WV WITHHOLDING
Enter WV withholding Only
3
A – Employer or Payer Information B – Employee or Taxpayer Information C – WV Tax Withheld
.00
Employer or payer ID from W-2, 1099, K-1, and/or WV/NRW-2
Name
WV WITHHOLDING
Check the appropriate box
Employer or Payer Name
Social Security Number
W-2 1099 K-1 WV/NRW-2
Address
.00
Enter State Abbreviation
(from Box #15 on W-2 or Box 11 on 1099)
City, State, ZIP
Income Subject to WV WITHHOLDING
Enter WV withholding Only
4
A – Employer or Payer Information B – Employee or Taxpayer Information C – WV Tax Withheld
.00
Employer or payer ID from W-2, 1099, K-1, and/or WV/NRW-2
Name
WV WITHHOLDING
Check the appropriate box
Employer or Payer Name Social Security Number
W-2 1099 K-1 WV/NRW-2
Address
.00
Enter State Abbreviation
(from Box #15 on W-2 or Box 11 on 1099)
City, State, ZIP
Income Subject to WV WITHHOLDING
Enter WV withholding Only
Total WV tax withheld from column C above.................................................... .00
If you have WV withholding on multiple pages, add the totals together and enter the GRAND total on line 11, Form IT-140
0
0
0
0
0
0
0
0
0
Form IT-140NRS.
–46–
sPecific insTrucTiOns fOr iT-140nrs
Important Notice: These instructions are based upon those statutes and reciprocity practices in effect
at the time of printing. Amendments may occur that would cause these instructions to change.
KENTUCKY, MARYLAND OR OHIO RESIDENTS
If your West Virginia income during 2012 was from wages and/or salaries only, you may le the Special
Nonresident Form IT-140NRS as a claim for refund of any West Virginia income tax withheld during
2012. If you had West Virginia income from a source other than wages and/or salaries, you must le
the West Virginia Income Tax Return (Form IT-140) and indicate residency status by checking the
Nonresident/Part-Year Resident box. You are not allowed a Schedule E credit against your West Virginia
income tax whenever your West Virginia income is other than wages and/or salaries. You should apply
for the appropriate credit on the income tax return led with your state of residence.
PENNSYLVANIA OR VIRGINIA RESIDENTS
If your West Virginia income during 2012 was from wages and/or salaries only AND YOU DID NOT
SPEND MORE THAN 183 DAYS WITHIN WEST VIRGINIA DURING 2012, you may le the Special
Nonresident Form IT-140NRS as a claim for refund of any West Virginia income tax withheld during
2012. If you had West Virginia income from a source other than wages and/or salaries, you must le
the West Virginia Income Tax Return (Form IT-140) and indicate residency status by checking the
Nonresident/Part-Year Resident box. You are not allowed a Schedule E credit against you West Virginia
income tax when your West Virginia income is other than wages and/or salaries. You should apply for
the appropriate credit on the income tax return led with your state of residence.
A domiciliary resident of Pennsylvania or Virginia who spends more than 183 days within
West Virginia during 2012 is also a resident of West Virginia for income tax purposes and is
required to le a resident return (Form IT-140) with West Virginia. A Schedule E credit would
not be allowed on the West Virginia return. You should apply for the appropriate credit on the
income tax return led with your state of residence.
SPECIAL NOTE: Residents of these states may be relieved from ling an annual claim for refund
of West Virginia taxes withheld from their wages and/or salaries by requesting Form WV/IT-104
(West Virginia Certicate of Nonresidence) from their employer. Form WV/IT-104 may be completed
and returned to the employer who would then be authorized to stop withholding West Virginia income
tax on wages and/or salaries earned in this state.
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IT-140NRS West Virginia Special Nonresident Income Tax Return (State of West Virginia)

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Completed 13 August 2020

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