Form WV/SEV-401H "Annual Return of Severance and Business Privilege Taxes for Providers of Health Care Items and Services" - West Virginia

What Is Form WV/SEV-401H?

This is a legal form that was released by the West Virginia State Tax Department - a government authority operating within West Virginia. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • The latest edition provided by the West Virginia State Tax Department;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form WV/SEV-401H by clicking the link below or browse more documents and templates provided by the West Virginia State Tax Department.

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Download Form WV/SEV-401H "Annual Return of Severance and Business Privilege Taxes for Providers of Health Care Items and Services" - West Virginia

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STATE OF WEST VIRGINIA
State Tax Department, Tax Account Administration Div
P.O. Box 773
Charleston, WV 25323-0773
Name
Address
Account #:
City
State
Zip
ANNUAL RETURN OF SEVERANCE AND BUSINESS PRIVILEGE TAXES
WV/SEV-401H
rtL085 v 6-Web
FOR PROVIDERS OF HEALTH CARE ITEMS AND SERVICES
Taxpayers required to file electronically will no longer receive returns for the tax types subject to the mandatory requirement
by mail. Please visit www.wvtax.gov for additional information.
Period Ending:
Due Date:
Extension Date:
M
M
D
D
Y
Y
Y
Y
Method of Accounting
ACCRUAL
CASH
FINAL
AMENDED
(Check One)
COMPUTATION OF TAX
1.
Total Gross Proceeds
.
2.
Bad Debt Deductions
.
3.
Contractual Allowances
.
4.
Taxable Total Gross Proceeds (Line 1 minus Lines 2 and 3)
.
5.
Tax Rate
0.05
6.
Tax Due (Multiply Line 4 by Line 5)
.
7.
Annual Credit - $500.00 Per Year or $41.67 Per Month for each Month Subject to this Tax
.
8.
Adjusted Tax Due (Line 6 minus Line 7)
.
9.
Total Estimated Payments for the Period Covered by this Return
.
10.
Credit for Overpayment from Prior Year Annual Return
.
11.
Total Payments / Credits (Add Lines 9 and 10)
.
12.
Total Tax Due (Line 8 minus Line 11)
.
13.
Overpayment Amount (Line 11 minus Line 8) If Line 8 is greater than Line 11, enter 0
.
14.
Amount of Line 13 to be Credited to Next Year's Tax
.
15. Amount of Line 13 to be Refunded (Line 13 minus Line 14)
.
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)
(Signature of preparer other than taxpayer)
(Address)
(Date)
MAIL TO: WEST VIRGINIA STATE TAX DEPARTMENT
Tax Account Administration Div
P.O. Box 773, Charleston, WV 25323-0773
FOR ASSISTANCE CALL (304) 558-3333 TOLL FREE (800) 982-8297
For more information visit our web site at: www.wvtax.gov
G
1
9
2
0
0
8
0
1
W
File online at https://mytaxes.wvtax.gov
STATE OF WEST VIRGINIA
State Tax Department, Tax Account Administration Div
P.O. Box 773
Charleston, WV 25323-0773
Name
Address
Account #:
City
State
Zip
ANNUAL RETURN OF SEVERANCE AND BUSINESS PRIVILEGE TAXES
WV/SEV-401H
rtL085 v 6-Web
FOR PROVIDERS OF HEALTH CARE ITEMS AND SERVICES
Taxpayers required to file electronically will no longer receive returns for the tax types subject to the mandatory requirement
by mail. Please visit www.wvtax.gov for additional information.
Period Ending:
Due Date:
Extension Date:
M
M
D
D
Y
Y
Y
Y
Method of Accounting
ACCRUAL
CASH
FINAL
AMENDED
(Check One)
COMPUTATION OF TAX
1.
Total Gross Proceeds
.
2.
Bad Debt Deductions
.
3.
Contractual Allowances
.
4.
Taxable Total Gross Proceeds (Line 1 minus Lines 2 and 3)
.
5.
Tax Rate
0.05
6.
Tax Due (Multiply Line 4 by Line 5)
.
7.
Annual Credit - $500.00 Per Year or $41.67 Per Month for each Month Subject to this Tax
.
8.
Adjusted Tax Due (Line 6 minus Line 7)
.
9.
Total Estimated Payments for the Period Covered by this Return
.
10.
Credit for Overpayment from Prior Year Annual Return
.
11.
Total Payments / Credits (Add Lines 9 and 10)
.
12.
Total Tax Due (Line 8 minus Line 11)
.
13.
Overpayment Amount (Line 11 minus Line 8) If Line 8 is greater than Line 11, enter 0
.
14.
Amount of Line 13 to be Credited to Next Year's Tax
.
15. Amount of Line 13 to be Refunded (Line 13 minus Line 14)
.
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)
(Signature of preparer other than taxpayer)
(Address)
(Date)
MAIL TO: WEST VIRGINIA STATE TAX DEPARTMENT
Tax Account Administration Div
P.O. Box 773, Charleston, WV 25323-0773
FOR ASSISTANCE CALL (304) 558-3333 TOLL FREE (800) 982-8297
For more information visit our web site at: www.wvtax.gov
G
1
9
2
0
0
8
0
1
W
File online at https://mytaxes.wvtax.gov