West Virginia 6-Month Payment Agreement Request

6-Month Payment Agreement Request
Form CD6
Form CD-6
(Oct 2016)

WEST VIRGINIA STATE TAX DEPARTMENT COMPLIANCE DIVISION
APPLICATION FOR SIX-MONTH PERSONAL INCOME TAX INSTALLMENT AGREEMENT PLAN
PLEASE NOTE: You should complete this form only after you have received a bill or notice from the
West Virginia State Tax Department.

Instructions for Form CD-6
Use Form CD-6 to request a monthly installment plan if you cannot pay the full amount you owe on a personal
income tax notice we have sent you. Payment plan requests using this form cannot exceed six months.
Do not submit this form if you are currently in bankruptcy, have unfiled personal income tax returns that are past
due, have a pending offer in compromise with the department or have unpaid personal income tax liabilities for
previous years.
Interest and penalties will continue to accrue until your tax liability is paid. No tax lien will be filed on payment
plans of six months or less. To limit the amount of interest and penalties charged, we urge you to pay as much
of the tax as possible with your request for a payment plan.
How the Installment Agreement Works
By entering into this installment agreement, you are agreeing to pay your total tax liability in timely monthly
installments instead of paying the total amount of tax due in full. You also are agreeing not to accrue additional
tax debt during the period of the payment plan. You will continue to receive billing notices for the total amount of personal
income tax due. These bills are automatically generated. Please continue to remit at least your monthly payment amount
due using either your payment plan voucher or the billing voucher.

If you do not make your payments on a timely basis or you accrue additional tax debt, enforcement actions will be
taken including the filing of a tax lien, wage garnishment, or bank levies to collect the total amount you owe.
Payment plans cost you substantially in interest and fees. We encourage you to avoid future tax liabilities by
examining your withholding or estimated tax payments to ensure that sufficient taxes are being withheld from
your income to meet your tax obligations.
You may submit this form by mail, by e-mail to [email protected], by fax to 304-558-1645, or by using the CD6 web application. Payments may be submitted electronically at https://mytaxes.wvtax.gov. If you mail your form with a
check or money order, be sure to include your account number or Social Security Number and make it payable to the West
Virginia State Tax Department. Send it to:
West Virginia State Tax Department
Compliance Division
P.O. Box 229
Charleston, West Virginia 25321-0229

Six-Month Personal Income Tax Installment Agreement Request Form
Clear all form fields

First Name

Middle Initial

Last Name

Social Security Number

___________________________________________________________ ______________________________
✔
Is this a joint return?
YES NO 

Spouse’s information, if applicable:
First Name
Middle Initial
Last Name

Social Security Number

___________________________________________________________ ______________________________
Home Address
__________________________________________________________________________________________
City, State and Zip Code
WV

__________________________________________________________________________________________
Did this address change since you last filed?

✔
YES NO 

Daytime Phone Number______ __________________ Home Phone Number ______ __________________

Please list the Letter ID number from the notice you received _____________________________________
Please enter your account number as shown on the notice __________________________________
Enter total amount you owe as shown on notice __________________________________________
Enter total number of months you are requesting for the installment payment agreement.*
____ months (Remember, you cannot exceed six months.)
*Your first installment payment will be due the 15th of the month following submission of this form.
By signing this payment installment form, you are agreeing that your balance due is correct; that you will continue to file
state tax return(s) and pay any additional state tax due in a timely manner during the term of agreement; and that you
will make timely monthly payments until your tax liability, including interest and penalties, is paid in full.
Your signature

Date

Spouse’s Signature

___________________________________________

Date

__________________________________________