WEST VIRGINIA CONSUMER SALES AND USE TAX                                                            West Virginia 
CST-284                                                                                                         State Tax 
REV 02/2022 TANGIBLE PERSONAL PROPERTY LISTING
            FOR NON-RESIDENT CONTRACTOR                                                                         Department

Pursuant to the provisions of W. Va. Code § 11-15-8b(c) a non-resident contractor must file within thirty (30) days of registration a listing of machinery, 
materials, supplies, and equipment that he has or will have on hand at the time he begins the fulfillment of the contract, including where the tangible personal 
property has been brought, shipped, or transported from outside this state upon which no Consumers Sales and Use Tax has been paid.
Any Consumers Sales or Use Tax due on the machinery, materials, supplies, and equipment included in this listing is to be paid at the time of filing this 
listing. (See Publication TSD-330 for details on calculation of use tax).

ACCOUNT #                           FEIN                                                 DATE

            TANGIBLE PERSONAL PROPERTY LISTING
            DESCRIPTION OF PROPERTY                                      AGE OF PROPERTY VALUE                  TAX (6%)

            MAIL TO:                                                                     TOTAL TAX DUE
            WEST VIRGINIA
                                                                                         CREDIT FOR TAX PAID IN 
            STATE TAX DEPARTMENT                                                         ANOTHER STATE
            P. O. BOX 1826
CHARLESTON, WEST VIRGINIA 25327-1826                                                     NET TAX DUE