WV/SEV-401
PAGE 1
(Rev 08/03)
2003
WEST VIRGINIA ANNUAL SEVERANCE TAX RETURN
Tax Year Beginning ____________________, 20_________, Ending __________________, 20________
The first line of this section is your account identification number.
Please reference your account number on all correspondence.
Please change name and address if not correct. If you quit busi-
ness, give the date and the name and address of new owner.
FORM OF BUSINESS (CHECK ONE) CHECK IF:
S CORPORATION
CONSOLIDATED
CORPORATION
SEPARATE
PARTNERSHIP
FINAL
INDIVIDUAL
AMENDED
L L C
BEFORE YOU COMPLETE THIS PAGE, YOU MUST COMPLETE THE SCHEDULE ON THE REVERSE SIDE OF THIS FORM
1.
1. Total Tax (From Severance Tax Computation Schedule Page 2)
2. a. Credit for Business Investment and Jobs Expansion, Corporate Headquarters
2a.
Relocation and Small Business Investment and Jobs Expansion
b. Credit for Industrial Expansion and/or Revitalization
b.
c.
c. Credit for Research and Development Projects
d.
d. West Virginia Capital Company Credit
3. Total Credits (lines 2a thru 2d) (Attach appropriate schedules)
3.
4. Adjusted Tax (line 1 less line 3)
4.
5. Annual Credit - $500 per year or $41.67 per month for each month engaged in business
5.
in West Virginia. Only one annual exemption may be claimed by each business entity
6. Net Amount of Tax (line 4 less line 5) (If line 5 is greater than line 4, enter 0)
6.
7. Total Estimated Payments Made for the Period Covered by this Return and Any Credit from Prior Years
7.
Overpayment . (Must attach credit letter)
8. Balance of Tax Due (line 6 less line 7) (If line 7 is greater than line 6 enter 0, and enter amount overpaid on
8.
line 13)
9. NON-WAIVABLE INTEREST
9.
10. ADDITIONS TO TAX
10.
11. PENALTY FOR UNDERPAYMENT OF ESTIMATED TAX
11.
12. TOTAL TAX AND LATE FILING CHARGES DUE (Add lines 8, 9, 10 and 11)
12.
13. If line 7 is larger than line 6, enter amount overpaid
13.
❏
❏
Please check one: Refund
Credit
Note: If you fail to designate credit or refund, the overpayment will be credited.
DO NOT USE SPACE BELOW
MAIL TO: WEST VIRGINIA STATE TAX DEPARTMENT
INTERNAL AUDITING DIVISION
P. O. BOX 425, CHARLESTON, WV 25322-0425
FOR ASSISTANCE CALL (304) 558-3333
TOLL FREE TO 1-800-WVA-TAXS (1-800-982-8297)
MAKE CHECKS PAYABLE TO THE:
WEST VIRGINIA STATE TAX DEPARTMENT