PDF document
- 1 -

Enlarge image
                                                               STATE OF WEST VIRGINIA
                                                                                                  
            State Tax Department, Tax Account Administration Div
                                                                                                  
            P.O. Box 425 
                                                                Charleston, WV 25322-0425

                                                                                                  _____________________________________________________________
                                                         NameTEST CORPORATION 1                                                                                                        Letter Id:  L0799739904
                                                                                                  1001_____________________________________________________________           LEE ST E Issued:     08/17/2020
                                                                       AddressCHARLESTON WV  25301-1725                                                                                Account #:  2275-4913
                                                                                                  _____________________________________________________________                        Period:     08/31/2020
            City                                                                      State                        Zip
                                                                                                  
WV/SEV-400C                       WEST VIRGINIA SEVERANCE TAX ESTIMATE
REV4-19
               ACCOUNT #                                                                 PERIOD                DUE                                                                             CONSOLIDATED SEPARATE
                                                                                     ENDING                    DATE
                                                                               SCHEDULE E - REPORT OF COAL PRODUCTION
                                  Tons from all seams must be reported in the county where severed from the ground
               KEY TO COUNTY FIPS CODES                                                                NAME OF COUNTY OF PRODUCTION                                                      COUNTY    SHORT TONS PRODUCED THIS PERIOD
                                                                                                       (If you only process purchased coal, enter N/A)                                   FIPS CODE (Round to Nearest Whole Ton)
001 Barbour    029 Hancock        057 Mineral                                  085 Ritchie                                                                                                                                                      .00
003 Berkeley   031 Hardy          059 Mingo                                    087 Roane
005 Boone      033 Harrison       061 Monongalia 089 Summers                                                                                                                                                                                    .00
007 Braxton    035 Jackson        063 Monroe                                   091 Taylor
009 Brooke     037 Jefferson      065 Morgan                                   093 Tucker
                                                                                                                                                                                                                                                .00
011 Cabell     039 Kanawha        067 Nicholas                                 095 Tyler
013 Calhoun    041 Lewis          069 Ohio                                     097 Upshur
015 Clay       043 Lincoln        071 Pendleton                                099 Wayne                                                                                                                                                        .00
017 Doddridge  045 Logan          073 Pleasants                                101 Webster
019 Fayette    047 McDowell       075 Pocahontas                               103 Wetzel                                                                                                                                                       .00
021 Gilmer     049 Marion         077 Preston                                  105 Wirt
023 Grant      051 Marshall       079 Putnam                                   107 Wood                                                                                                                                                         .00
025 Greenbrier 053 Mason          081 Raleigh                                  109 Wyoming
027 Hampshire  055 Mercer         083 Randolph                                                                                                                                                                                                  .00
                                                                                                       TAX COMPUTATION
                             COAL                                                                              (COLUMN 1)                                                                (COL 2)            (COLUMN 3)
                                                                                                       TAXABLE AMOUNT                                                                    RATE      TAX DUE (COLUMN 1 X COLUMN 2)

1. GROSS VALUE OF COAL SEVERED (NON-THIN SEAM)                                                                                                                                         . 0.05                                                   .

2. VALUE ADDED FROM PROCESSED COAL                                                                                                                                                     . 0.05                                                   .

3. QUALIFIED THIN SEAM 37" TO 45"                                                                                                                                                      . 0.02                                                   .

4. QUALIFIED THIN SEAM LESS THAN 37"                                                                                                                                                   . 0.01                                                   .

5. STEAM COAL (JULY 1, 2020 THROUGH JUNE 30, 2021)                                                                                                                                     . 0.037                                                  .

6.  CREDITS (INVESTMENT CREDITS AND $41.67 PER MONTH ANNUAL EXEMPTION)......................................................................................                                                                                    .

7.  ADD LINES 1 THROUGH 5, SUBTRACT LINE 6..................................................................................................                    Total Tax Due                                                                   .

MAIL TO:       WEST VIRGINIA STATE TAX DEPARTMENT  
               Tax Account Administration Div  
               P.O. Box 425   
               Charleston, WV 25322-0425  
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  
                                                                                                                                                                                         G     0     1     2     0     1     9     0     1     W



- 2 -

Enlarge image
WV/SEV-400C            WEST VIRGINIA COAL SEVERANCE TAX ESTIMATE                  ACCOUNT #
CONTINUED

The production of waste coal must be reported quarterly on the waste coal severance tax quarterly estimate return (WV/SEV-400W). If you have
income from the production of other natural resources, you must also file the severance tax estimate (WV/SEV-400). If you file more than one type
of severance tax return, you may claim ONLY one $41.67 per month annual exemption.

                                                     SIGN YOUR RETURN
Under penalty of perjury, I declare that I have examined this application, accompanying documents, 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     EMAIL ADDRESS                                 TELEPHONE

SIGNATURE OF PREPARER OTHER THAN TAXPAYER    ADDRESS                                       DATE






PDF file checksum: 2265155222

(Plugin #1/8.13/12.0)