Form Wv/bot-300f - Business And Occupation Tax Return For Synthetic Fuels Page 2

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If business was sold or discontinued give date, name and address of
new owner:
New Owner Name:
MAKE CHECKS PAYABLE TO:
WEST VIRGINIA STATE TAX DEPARTMENT
FOR ASSISTANCE CALL: (304) 558-3333
TOLL FREE: (800) 982-8297
New Owner Address:
MAIL TO:
WEST VIRGINIA STATE TAX DEPARTMENT
Tax Account Administration Div
P.O. Box 425
Charleston, WV 25322-0425
SIGNATURE
DATE

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