West Virginia Non-resident Income Tax Agreement

Non-resident Income Tax Agreement
Form NRW4
NRW-4
REV. 02/2021

West Virginia Nonresident Income Tax Agreement
Read Instructions on Reverse Side

West Virginia
State Tax
Department

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

West Virginia
Identification Number

Zip Code

City/Town

Federal
Identification Number

State

Social Security Number or Federal
Identification Number

Zip Code
Spouse’s
Social Security Number

Type of Nonresident:

Type of Organization: (check only one)
Partnership

S Corporation

Estate

Trust

Limited Liability Company

Individual

Corporation

Partnership

Nonresident’s Taxable Year:

Taxable Year of Organiation:

Calender Year
Fiscal Year Ending ________________________________________

Calender Year
Fiscal Year Ending ____________________________

State of Residence or Commercial Domicile:_______________________

State of Commercial Domicile: ______________________
Internal Revenue Service center where organization’s federal return
is filed:

Internal Revenue Service center where nonresident’s federal return 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, CIT-120, or PTE-100) 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 an 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-name Organization (Pass-through entity) that begins after today’s date.
SIGN
HERE
(Signature of Nonresident Partner, Shareholder, or Beneficiary, or of an Authorized Corporate Officer)
(Print Named Signed Above)
(Mailing Address if Different from Above)

Form NRW-4

(Date)

West Virginia State Tax Department

Page 1

WEST VIRGINIA NONRESIDENT INCOME TAX AGREEMENT
INSTRUCTIONS
Who May File: Any nonresident individual, corporation, or partnership 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 West Virginia 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 file with the organization’s
West Virginia income tax return, (2) one copy to be retained by the pass-through entity, and (3) one copy of 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 distributree tile files this form the tax return file 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 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, PTE-100, or CIT-120) for more than 60 days after the due date of the return (determined by including any
authorized extensions(s) of time for filing such return, or to timely pay West Virginia income tax for any taxable year covered
by this agreement.

Form NRW-4

West Virginia State Tax Department

Page 2