Wv Nrw 4 Form – Fill Out and Use This PDF

		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

Nonresident's Taxable Year:

Taxable Year of Organization:

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)

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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).

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