1. STATE OF WEST VIRGINIA
INDIVIDUAL INCOME TAX DECLARATION
FOR ELECTRONIC FILING
For The Year January 1 - December 31, 2008
WV-8453OL
00 9
IRS DCN
Rev 10/08
Your first name and initial Last name Your Social Security Number
If a joint return, spouse's first name and initial Last name, if different Spouse's Social Security Number
2008 Home Address (number and street) Daytime telephone #
City, town or post office, state and ZIP code
Part I Tax Return Information (Whole dollars only)
Federal Adjusted Gross Income (Form IT-140, Line 1)...................................................................... 1
1.
West Virginia Income Tax (Form IT-140, Line 8)................................................................................ 2
2.
Balance Due ( IT-140, Line 22)........................................................................................................... 3
3.
Refund (Form IT-140, Line 27)............................................................................................................ 4
4.
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Part II Direct Deposit or Electronic Funds Withdrawal
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The first two numbers of the RTN must be 01 through 12 or 21 through 32
5. Routing transit number (RTN)
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6. Depositor account number (DAN)
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7. Electronic Funds Withdrawal (Checking Only; No Partial Payments)
8. Type of account: Checking Savings (Direct Deposit Only)
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Part III Declaration of Taxpayer
I consent that my refund be directly deposited or my payment due be withdrawn by electronic debit as designated in Part II. I further authorize the State of West Virginia, to initiate debit entries and to initiate, if necessary,
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credit entries as adjustments for any entries in error into my Checking or Savings account as indicated above in Part II and the Financial Institution indicated above in Part II, to credit the same any amount(s) owed to
me by the State of West Virginia. If I have filed a joint return, this is an irrevocable appointment of the other spouse as an agent to receive the refund or authorize the electronic debit.
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Under penalties of perjury, I declare that I have compared the information contained on my return with the information I have provided to my Electronic Return Originator and that the amounts described in Part I above
agree with the amounts shown on the corresponding lines of my 2008 West Virginia income tax return. To the best of my knowledge and belief, my return is true, correct and complete. I consent that my return, including S
this declaration and accompanying schedules and statements, be sent to the West Virginia Department of Revenue, upon such request from the Department. If I have filed a joint federal and state return, I understand
that, if there is an error on either return, my state return will be rejected. If the processing of my return or refund is delayed, I authorize the Department of Revenue to disclose to my ERO and/or the transmitterT
the reason(s) for the delay, or when the refund was sent.
Please
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Sign Here Your signature Date Spouse's signature Date
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Thank you for e-filing your West Virginia state income tax return.
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Please review the checklist below for further instructions.
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CHECKLIST
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1) The West Virginia state acknowledgement will follow the IRS acknowledgement and will be sent through your e-mail account.
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If the state acknowledgement is not received within 10 days after filing, DO NOT send a copy of your tax return. Please call
the WV State Tax Department at 1-800-982-8297 or 304-558-3333 for further instructions.
2) Attach all required forms and schedules to the back of the WV-8453OL. These include W-2, 1099 R, Schedule H, and form
WV-8379, Injured Spouse Allocation. Sign the document and retain for your records for a period of no less than 3 years.
DO NOT MAIL THIS FORM. The State Tax Department reserves the right to review this signature document at any time during
the retention period. This document must be readily available to mail to the State Tax Department upon request.
3) DO NOT attach balance due payments to the WV-8453OL. Please attach a check or money order to the completed IT-140V
payment voucher. To avoid billing errors or duplicate returns, DO NOT SEND A COPY OF YOUR TAX RETURN. If the on-line
software does not print the IT-140V, you can obtain one from our website at www.wvtax.gov. If you have questions
concerning the receipt of your return by the Department of Revenue, please call the numbers listed above for further instructions.