STATE OF WEST VIRGINIA
                                                                                                 
           State Tax Department, Tax Account Administration Div
                                                                                                 
           P.O. Box 1667 
                                                               
                                                               Charleston, WV 25326-1667

           H & R BLOCK OF POINT PLEASANT_____________________________________________________________                                                                                                              Letter Id:         L0028590080
                                                                                Name
                                                                                                 1312_____________________________________________________________EASTERN AVE                                      AccountIssued:#: ________________01/08/2019
                                                                  AddressGALLIPOLIS OH  45631-1731                                                                                                                 Account #:          2188-4987
                                                                                                 _____________________________________________________________                                                     Period:             03/31/2019
                                                                                                 City                                                                      State                        Zip

WV/IT-101QWEST VIRGINIA EMPLOYER'S QUARTERLY RETURN OF INCOME TAX WITHHELD
rtL049 v.28

                                                                                                                See instructions on reverse side before completing 
Quarter Ending:                                Due Date:                                                        this form.  Please type or print within the boxes.                                                                          AMENDED
 Part 1: Complete Lines 1-10

1.  Number of employees who received wages, tips and other compensation for the quarter

2.  Wages, tips and other compensation for the quarter
                                                                                                                                                                                                                                                              .
3.  Total WV income tax withheld from wages, tips and other compensation for the quarter
                                                                                                                                                                                                                                                              .
                                                                                                                                                                                                                                      Total WV Liability for
4.  WV ________ Liability                   5. WV ________ Liability                                            6.                                                                                         WV ________ Liability    7.
                                                                                                                                                                                                                                     Quarter (Must Equal Line 3)

                        .                                                                         .                                                                                                                .                                          .
8.  Total payments for the quarter
                                                                                                                                                                                                                                                              .
9.  Balance due     (If line 7 is greater than line 8, enter difference here)
                                                                                                                                                                                                                                                              .
10. Overpayment    (If line 8 is greater than line 7, enter difference here)                                                                                                                               Refund
                                                                                                                                                                                                                                                              .
 Part 2: Tell us about your business.  If not applicable to your business, leave blank.

If your business has stopped paying wages, check here                                             and enter final date you paid wages
                                                                                                                                                                                                                                  M M  D    D  Y Y            Y           Y
 Part 3: Sign your return.
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.

(Signature of Taxpayer)                        (Name of Taxpayer - Type or Print)                                                                                                                          (Title)                    (Date)

(Person to Contact Concerning this Return)                                                                                                                                                                 (Telephone Number)

(Signature of Preparer other than Taxpayer)    (Address)                                                                                                                                                   (Date)

           MAIL TO: WEST VIRGINIA STATE TAX DEPARTMENT
                        Tax Account Administration Div
                        P.O. Box 1667 , Charleston, WV 25326-1667
           FOR ASSISTANCE CALL (304) 558-3333 TOLL FREE (800) 982-8297
           For more information visit our web site at: www.tax.wv.gov
                        File online at https://mytaxes.wvtax.gov                                                                                                                                                   P     4     3     2     0     1     0     0     1     W

NOTE: You will no longer receive a blue payment voucher         INSTRUCTIONS FOR COMPLETING FORM WV/IT-
booklet. You will now receive the WV/IT-101Q return along       101Q
with the next 3 months IT-101V payment vouchers. You are 
encouraged to view your tax accounts, file tax returns and      Part 1:
make payments online by registering for MyTaxes. Save the       Line 1 - Enter number of employees you had for the quarter. If 
stamp! Visit the website at https://mytaxes.wvtax.gov           you had no employees during this period, enter zero.
                                                                Line 2 - Enter total amount of compensation paid to these 
All employers are monthly payers and quarterly filers with the  employees for the quarter. If no compensation was paid during 
exception of employers who withhold less than $600 annually     this period, enter zero.
OR employ certain domestic and household employees. Please      Line 3 - Enter total amount of West Virginia Income Tax 
visit the website for guidelines for making payments, filing    withheld for the quarter. If no withholding during this period, 
returns, Annual Reconciliations,  W-2's, 1099's, etc. at:       enter zero.
www.tax.wv.gov/Business/Withholding/HelpandGeneralInform        Box 4 - Enter the total tax liability due for the first month in 
ation.                                                          the quarter. If no liability was accrued during this month, enter 
                                                                zero.
Payment of Tax Due: Monthly payments are required.              Box 5 - Enter the total tax liability due for the second month in 
Payments are submitted separately from the return. Payments     the quarter. If no liability was accrued during this month, enter 
along with form WV/IT-101V are due the 15th day of the month    zero.
following the close of the month. Payments received after the   Box 6 - Enter the total tax liability due for the third month in 
15th of the following month are LATE. Interest and penalty will the quarter. If no liability was accrued during this month, enter 
be assessed.                                                    zero.
                                                                Box 7 - Enter the total tax liability due for the quarter (sum of 
Return Filing: A separate quarterly return, form WV/IT-101Q     month 1 + month 2 + month 3). The amount should be equal to 
is due for each quarter in the calendar year. The WV/IT-101Q is the total income tax withheld from wages (Line 3).
due by the last day of the month following the close of the     Line 8 - Enter the total payments submitted to the State Tax 
quarter. The return must be completed and submitted to the WV   Department for the quarter. If none, enter zero.
State Tax Department even if you had no employees and no tax    Line 9 - Compare line 8 to box 7, if box 7 is greater than line 
has been withheld.                                              8, enter the difference here and follow the Underpayment
                                                                instructions. If box 7 is less than line 8, go to Line 10. If box 7 
Underpayment: Enclose a payment if Line 9 of the WV/IT-         equals line 8, go to Part 2.
101Q has a balance due.                                         Line 10 - Compare line 8 to box 7, if line 8 is greater than box 
                                                                7, enter the difference here. The overpayment credit will be 
Amended: To correct a previously filed return, please check the applied to the next period. Or  to request a refund, check the 
box for AMENDED. Be sure the period ending date is for the      box.
period that needs corrected.                                    CREDITS AND/OR REFUNDS MAY BE CAPTURED 
                                                                AND APPLIED TO OUTSTANDING TAX LIABILITIES.
Changes: If it becomes necessary to change your filing 
frequency or address during the year, please notify the         Part 2:  If not applicable to your business, leave blank.
Withholding Unit by fax at 304-558-1150.  Your Withholding 
Tax account will be adjusted accordingly and, if necessary,     If your business has stopped paying wages, check the box and 
additional forms will be issued.                                enter the date you last paid wages in the space provided. 
                                                                Complete this section only if you have no employees and do 
Employers who employ twenty-five (25) or more employees         not expect to have employees in the future. By completing this 
are required to file and pay electronically at                  section, you authorize the closing of your Withholding Tax 
https://mytaxes.wvtax.gov Employers who fail to meet this       account.
requirement are subject to a penalty of $25 per employee.
                                                                Part 3:  An unsigned return is not a valid return !Your return 
                                                                must be signed by a company representative, designated 
For Additional Information, please visit our website:           preparer, owner or officer, partner or member. Please include a 
www.tax.wv.gov or contact:                                      telephone number should we need to contact you concerning 
                                                                your return.

               Taxpayer Services Division                       INSTRUCTIONS FOR COMPLETING WV/IT-101V
                   (304) 558-3333
                   1-800-WVA-TAXS                               Cut coupon along line
                   (800) 982-8297
                   For the hearing impaired                     Enter TOTAL REMITTANCE in the box
                   TDD 1-800-282-9833
                                                                Payment is due the 15th day of the month following the close 
                                                                of the month. Payments received after the 15th of the following 
                                                                month are LATE. Interest and penalty will be assessed.