INSTRUCTIONS: AFFIDAVIT OF WEST VIRGINIA INCOME TAX WITHHELD BY EMPLOYER (Form IT-102-1)

West Virginia employees who are unable to secure a form W-2 documenting income tax withheld from their wages should file a form IT-102-1 instead. This form is an affidavit certifying that this income tax has been withheld from your wages. This document can be obtained from the website maintained by the government of West Virginia.

Affidavit Of West Virginia Income Tax Withheld By Employer IT-102-1 Step 1: In the blank box where indicated, enter the taxable year of withholding for which you are filing.

Affidavit Of West Virginia Income Tax Withheld By Employer IT-102-1 Step 2: On the four blank lines on the left, enter your employer's name, street address or P.O. box number, city, state and zip code.

Affidavit Of West Virginia Income Tax Withheld By Employer IT-102-1 Step 3: On the four blank lines on the right, enter your name, street address or P.O. box number, city, state and zip code.

Affidavit Of West Virginia Income Tax Withheld By Employer IT-102-1 Step 4: In the blank box below on the left, enter the total wages received from this employer.

Affidavit Of West Virginia Income Tax Withheld By Employer IT-102-1 Step 5: In the blank box on the right, enter the West Virginia income tax withheld.

Affidavit Of West Virginia Income Tax Withheld By Employer IT-102-1 Step 6: On the blank line where indicated, enter the calendar year for which you are filing.

Affidavit Of West Virginia Income Tax Withheld By Employer IT-102-1 Step 7: The form should be signed in the presence of an authorized official. Enter your signature on the next blank line.

Affidavit Of West Virginia Income Tax Withheld By Employer IT-102-1 Step 8: The authorizing official will enter their signature, the county, state and date where indicated.

Affidavit Of West Virginia Income Tax Withheld By Employer IT-102-1 Step 9: On the next blank line at the bottom of the page, enter the reason why your employer did not give you a form W-2.

Affidavit Of West Virginia Income Tax Withheld By Employer IT-102-1 Step 10: On the next blank line, enter your employer's present name and address if different from the name and address given above. On the last blank line, enter any other information that can help locate your employer.