STATE OF WEST VIRGINIA
          State Tax Department, Tax Account Administration Div
          P.O. Box 3943 
          Charleston, WV 25339-3943

          Name

          Address

          City                                         State                 

WV/IT-103               WEST VIRGINIA WITHHOLDING YEAR END RECONCILIATION
IT103 v.5                                   To be filed on or before January 31.

Account #:  ______________                                                                 Calendar Year: ___________________

First Quarter                                                                                                                                         .00

Second Quarter                                                                                                                                        .00

Third Quarter                                                                                                                                         .00

Fourth Quarter                                                                                                                                        .00

TOTAL FOR THE YEAR                                                                         (A)                                                        .00

Number of Withholding tax statements (W-2's/1099's) transmitted 

Total WV tax shown as withheld by all statements transmitted                               (B)                                                        .00

                                            DO NOT SEND PAYMENT WITH THIS FORM
Attach an explanation if Block (A) is different from Block (B). If there is an underpayment, visit https://mytaxes.wvtax.gov to remit
payment separately using MyTaxes or visit our website to download an IT-101V payment voucher.  If there is an overpayment, an
amended IT-101Q return for period(s) involved is required.  Check the appropriate box to request the refund.

                                                                Sign Your Return
Under penalty of perjury, I declare that I have examined this return (including accompanying schedules and statements) and to the best of my knowledge
and belief it is true and complete.

(Signature of taxpayer)                     (Name of taxpayer - type or print)     (Title)                     (Date)

(Person to contact concerning this return)                      (Telephone number)             (E-mail address)

(Signature of preparer other than taxpayer)                     (Address)                                      (Date)

          MAIL TO: WEST VIRGINIA STATE TAX DEPARTMENT
                        Tax Account Administration Div
                 P.O. Box 3943 , Charleston, WV 25339-3943
          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

End of Year Reconciliation and Withholding Tax Statements (W-2's) 

Employers are required to furnish each employee a Withholding Tax Statement (Form W-2 or an approved substitute)
on or before January 31 of the following year. A copy of each employee’s Withholding Tax Statement (W-2) is to be
submitted to the State Tax Department accompanied with form WV/IT-103 no later than January 31 of the succeeding
year. We encourage you to file the WV/IT-103 and upload W-2’s online using https://mytaxes.wvtax.gov.

Employees who are filing for twenty-five or more employees are required to file all data by electronic media. Visit
www.tax.wv.gov for guidelines and view the IT-105 Specifications for information on filing W-2’s and 1099 forms
electronically. Failure to do so can result in an assessment of penalty in the amount of $25.00 per information return for
whom the return was not filed electronically. Lack of forms is not a valid excuse for failure to file a return.

For additional information, please visit our website www.tax.wv.gov or contact:

                                Taxpayer Services Division
                                (304) 558-3333
                                1-800-WVA-TAXS
                                (800) 982-8297

                  DO NOT ALTER YOUR TAX RETURNS INDICATING CHANGES

If there has been a change in your business please fill out this form by checking the appropriate box(es) and ensure
your account number or EIN is indicated at the top of the form. Any change indicated on this form will be adjusted
accordingly.

                                EMPLOYER'S WITHHOLDING CHANGE ORDER
Employer's Identification Number
listed with West Virginia   
                                **INDICATE CHANGES  ONLY**
FEIN (WV State ID# if different)
                                                                    Filing Status      Annual to Quarterly
attach explanation
Business Name 

Employer's Name (if different) 

Address                         City                                                   State              Zip Code

If you are no longer liable for West Virginia withholding tax, check explanation below;
Business Sold Date Effective:  ___________________________________                     Business permanently discontinued Date Effective:  ____________________
Ceased paying wages  Date Effective:  _____________________________                    Other - Specify:  ________________________________________________
Date                            Signature

                  Mail to:  WV State Tax Department  PO Box 3943, Charleston  WV  25339-3943 

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