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

           Name

           Address                                                                     Account #:

           City                                          State                 Zip
WV/SEV-401T                          ANNUAL TIMBER SEVERANCE TAX RETURN
rtL100 v.7-Web

Period Ending:                               Due Date:                                 Extension Date:
                                                                                                           M M D     D Y Y Y     Y
    Check if:      CONSOLIDATED                     SEPARATE                           FINAL                      AMENDED

                                                              TAX COMPUTATIONS
              (COLUMN 1)                     (COLUMN 2)           (COLUMN 3)           (COLUMN 4)            (COL 5)   (COLUMN 6)
    TYPE OF ACTIVITY                       GROSS PROCEEDS                 TAX          TAXABLE AMOUNT        RATE      GROSS TAX
                                              OF SALE             MULTIPLIER           (COL 2 X COL 3)                 (COL 4 X COL 5)
1.  TIMBER SOLD AT THE POINT                                              1.00                               0.015
    IT IS CUT AND DELIMBED                                    .                                          .                            .
2.  TIMBER CUT AND TAKEN TO                                               0.75                               0.015
    COLLECTION POINT IN WOODS                                 .                                          .                            .
3.  TIMBER CUT AND DELIVERED                                              0.50                               0.015
    TO SAWMILL FOR SALE                                       .                                          .                            .
4.  TIMBER CUT AND PROCESSED                                              0.25                               0.015
    INTO OTHER PRODUCTS                                       .                                          .                            .
5.  Gross Tax (Add Column 6, Lines 1 through 4)                                                                                       .
6. Total Credits (Schedule TC - Line 3 on Page 2 - Attach Appropriate Schedule)                                                       .
7. Adjusted Tax (Line 5 minus Line 6) If line 6 is greater than Line 5, enter 0                                                       .
    Total Payments made for the Period Covered by this Return and any Credit from Prior Years Overpayment
8.  (Must attach credit letter)                                                                                                       .
9. Balance of Tax Due (Line 7 minus Line 8)  If Line 8 is greater than Line 7, enter 0                                                .
10. NON-WAIVABLE INTEREST
                                                                                                                       For Internal
11. ADDITIONS TO TAX
                                                                                                                         Use Only
12. PENALTY FOR UNDERPAYMENT OF ESTIMATED TAX

13. Overpayment Amount (Line 8 minus Line 7) If Line 7 is greater than Line 8, enter 0                                                .
14. Amount of Line 13 to be Credited to Next Year's Tax                                                                               .
15. Amount of Line 13 to be Refunded (Line 1 3minus Line 1 )4                                                                         .

              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     6     2     0     7     1     6     0     1     W

WV/SEV-401T                                 ANNUAL TIMBER SEVERANCE TAX RETURN
rtL100V.7-Web
                                                                                                         Account #: _______________

   SCHEDULE A:  Enter the Amount of Timber Harvested and the Income Attributable for the Taxable Year
                                                        Quantity*                        Gross Proceeds of Sale (Dollar Value)

1. Sawed Timber (Board Feet)                                                   . 00                                                .
2. Pulp Wood Harvested (Tons)                                                  . 00                                                .
3. Other (specify)                                                             . 00                                                .
*For Sawed Timber, provide the number of Board Feet of timber harvested. For Pulpwood, provide the number of Tons of pulpwood harvested.

                                                        SCHEDULE TC - Tax Credits

1. Annual Credit - $500 per year or $41.67 per month for each month engaged in business in West Virginia                           .
2. Manufacturing Investment Tax Credit (Must attach documentation)                                                                 .
3. Total Credit (Add Lines 1 and 2)  Enter here and on Page 1, Line 6                                                              .

                                                        Sign Your Return
Under penalties 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)

Please answer all questions:
1. If you purchased this business in the past twelve (12) months, give the previous owners full name and address:

2. During the period covered by this return, did you:
   a.Cease Business?                        Sell or otherwise dispose of your business?          Exact Date

   b.If business was sold, give exact name and address of new owner

3. Address where your records are located

4. Principal place of business in West Virginia

5. Nature of business conducted. (Describe in Detail)

6. Give name and account number of any additional business(es) operated in West Virginia by the reporting taxpayer

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