WV4868 B
Form IT-140     APPLICATION FOR  EXTENSION OF TIME TO FILE
File this form to request a six-month extension of time to file your West Virginia Personal Income Tax Return. 
Request for extension to file must be filed before the original due date of the return. Extensions received after this date will be denied. 
Your return must be filed no later than October 17 after the original due date. 

This form is NOT an extension of time to PAY personal income taxes due. 
                      TAX YEAR 
ENDING 
MM DD YYYY
                                             TAXPAYER INFORMATION
SOCIAL SECURITY                                            *SPOUSE’S SOCIAL 
NUMBER                                                     SECURITY NUMBER
                                                                                YOUR 
LAST NAME                                                  SUFFIX               FIRST                                                                                 MI
                                                                                NAME
                                                                                SPOUSE’S 
SPOUSE’S                                                   SUFFIX               FIRST                                                                                 MI
LAST NAME                                                                       NAME
FIRST LINE OF                                              SECOND LINE OF 
ADDRESS                                                       ADDRESS

    CITY                                                      STATE             ZIP CODE

TELEPHONE                            EMAIL                                            EXTENDED DUE DATE
NUMBER                                                                                                                                                      MM/DD/YYYY

                                                  CALCULATION

a. Total income tax liability.............................................................................................................................. a.                  .00

b. Total payments (West Virginia withholding and/or credit for estimated payments)...................................                                       b.                  .00

c. Amount of West Virginia personal income tax due (subtract line b from line a)........................................                                    c.                  .00

                                                       NOTE

This form and payment must be  fi led on or before the due date of the return. A penalty is imposed for late  fi                                                        ling/late payment 
of tax unless reasonable cause can be shown. If you receive an extension of time for federal income purposes and expect to 
owe no West Virginia income tax, you are not required to  file this form. To receive the same extension for state tax purposes, 
     you need only note on your West Virginia Personal Income Tax Return that a federal extension was granted. 

                                                  Mail this form to:
                                             West Virginia Tax Division
                                           Tax Account Administration
                                                  P.O. Box 2585
                                             Charleston, WV 25329-2585

                      This form must be complete and submitted in full.

                                 DO NOT CUT OR RESIZE THIS FORM.

                                                                                *P40012201A*
                                                                                    P40012201A
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