WV/NRW-4                     West Virginia Nonresident Income Tax Agreement
     REV 08-10    B
                                                      Read Instructions on Reverse Side
Part I:
          ORGANIZATION NAME AND MAILING ADDRESS                                   NONRESIDENT NAME AND MAILING ADDRESS

Name  (please type or print)                                         Name  (please type or print)

Post Office or Street Address                                        Post Office or Street Address

City/Town                               State             Zip Code   City/Town                                     State                        Zip Code

West Virginia Identification Number Federal Identification Number             Social Security Number         Spouse's Social Security Number
                                                                         or Federal Identification Number

Type of Organization:  (check only one)                                  Type of Nonresident:
          Partnership               S Corporation             Estate              Individual            Corporation           Partnership
          Trust                     Limited Liability Company
Taxable Year of Organization:                                            Nonresident's Taxable Year:
          Calendar Year                                                           Calendar Year
          Fiscal Year Ending                                                      Fiscal Year Ending

State of Commercial Domicile:                                            State of Residence or Commercial Domicile:

Internal Revenue Service Center Where Organization's Federal Return      Internal Revenue Service Center Where Nonresident's Federal Return
is Filed:                                                                Is Filed:
City                                    State                            City                                      State

Part II:
     I declare that the above-named Distributee is a nonresident of West Virginia and that the nonresident Distributee hereby agrees to timely file West
Virginia Income Tax Returns (Form IT-140 or WV/CNF-120) and pay any income tax due; that the Distributee will include in that return the portion of the
above-named Organization’s West Virginia income or gain attributable to the nonresident Distributee’s interest in such Organization for the taxable year
of the Distributee during which this Form is filed with the Organization and for each succeeding taxable year for which the Distributee receives actual
or deemed distributions of West Virginia source income or gain; and that this Agreement remains in effect until it is revoked by either the Distributee or
the Tax Commissioner.
SIGN
HERE
          (Signature of Nonresident Partner, Shareholder, or Beneficiary, or of Authorized Corporate Officer)

          (Print Name Signed Above)

          (Mailing Address if Different from Above)                                                                (Date)

Part III:                          NOTICE OF REVOCATION OF NONRESIDENT INCOME TAX AGREEMENT
                                        WARNING:  COMPLETE ONLY IF REVOKING AGREEMENT
Notice is hereby given that the West Virginia Nonresident Income Tax Agreement (Form WV/NRW-4) previously executed by or on behalf of the above-
named Nonresident is revoked for taxable years of the above-named Organization (Pass-through entity) that begins after today's date.

SIGN
HERE
          (Signature of Nonresident Partner, Shareholder, or Beneficiary, or of Authorized Corporate Officer)

          (Print Name Signed Above)

          (Mailing Address if Different from Above)                                                                (Date)
                                                                     -16-

             WEST VIRGINIA NONRESIDENT INCOME TAX AGREEMENT

                                                         INSTRUCTIONS

Who May File:  Any Nonresident individual or C corporation who has West Virginia source income derived from a partnership, S corporation,
estate, trust, or limited liability company  (“Organization”) who desires to not have West Virginia income tax withheld by that Organization
as provided in W.Va. Code § 11-21-71a, must complete a West Virginia Nonresident Income Tax Agreement (Form WV/NRW-4) and timely
file it with the Organization.  A corporation is a nonresident if its commercial domicile is located in another State.

When and Where to File:  This Form must be completed and filed with the Organization on or before the last day of the Organization’s
taxable year.  If the Distributee receives West Virginia source income from more than one such Organization, a separate Form WV/NRW-
4 must be filed with each Organization in order to avoid withholding by that Organization.  The Organization may copy this form or use
a facsimile to distribute as follows:  (1) one copy to be filed with the Organization's West Virginia income tax return, (2) one copy to be
retained by the pass-through entity, and (3) one copy for the nonresident distributee.

West Virginia Income Tax Withholding for Nonresidents:  Every Organization distributing West Virginia source income to a nonresident
distributee is required to withhold West Virginia income tax on the amount thereof distributed to Nonresident Distributee unless the
Nonresident Distributee timely files this Form with the Organization and the Organization attaches a copy of it to its West Virginia income
tax return filed for the taxable year of its receipt.  The withholding tax rate is 6.5% of distributions of West Virginia source income (whether
actual or deemed distributions).  The amount of tax withheld and remitted by the Organization is allowed as a credit against the Distributee’s
West Virginia income tax liability for that taxable year.

Nonresident Agreement:  Once this  agreement is executed, it must be filed with the Organization to avoid having withholding tax deducted
from further distributions (actual or deemed).  This agreement first applies to the taxable year of the Organization during which the
Organization receives a properly executed agreement from the Nonresident Distributee.

Duration of Agreement:  Once this Agreement is filed with the Organization, it remains in effect until it is revoked by the Nonresident
Distributee, or by the Tax Commissioner.

Revocation:

1.  A Nonresident Distributee may revoke this Agreement by completing this Form and filing it with the Organization through which
it receives West Virginia source income.  Revocation applies prospectively, meaning that  it first applies to taxable years of the Organization
which begin after revocation is filed with that Organization.

2.  The Tax Commissioner may revoke this Agreement if  the Nonresident Distributee fails to file a West Virginia income tax return
(IT-140, WV/SPF-100 or WV/CNF-120) for more than 60 days after the due date of the return (determined by including any authorized
extension(s) of time for filing such return, or to timely pay West Virginia income tax for any taxable year covered by this agreement).

                                                             -17-