Get WV GSR-01 2014

Clear All Values GSR-01 Rev. 10/14 Print Your Return West Virginia Request for Statement of Good Standing State Tax Department Taxpayer Identification Number Complete Business Name Business Location Mailing Address Street City State Zip Type of business check one Partnership Sole Ownership Corporation/LLC Other I understand that in the event that this business is not in good standing with the Tax Department I will be notified in writing as to what tax returns or tax payments are considered not filed or paid and who to contact with any questions regarding that situation. By signing this Request for Statement of Good Standing I certify under penalty of perjury that I am the taxpayer or the taxpayer s authorized representative and am entitled to receive the result of this request. If you are a CPA or Attorney completing this Request for Statement of Good Standing for a business of which you are not a principle a principle of the business must ALSO sign this request as the taxpayer. If you are authorizing release of information for someone who is not a CPA or Attorney this form must be notarized. Taxpayer Signature Title Date Print Name Phone E-mail CPA/Attorney Signature Signature of person other than taxpayer CPA or attorney Form must be notarized. Clear All Values GSR-01 Rev* 10/14 Print Your Return West Virginia Request for Statement of Good Standing State Tax Department Taxpayer Identification Number Complete Business Name Business Location Mailing Address Street City State Zip Type of business check one Partnership Sole Ownership Corporation/LLC Other I understand that in the event that this business is not in good standing with the Tax Department I will be notified in writing as to what tax returns or tax payments are considered not filed or paid and who to contact with any questions regarding that situation* By signing this Request for Statement of Good Standing I certify under penalty of perjury that I am the taxpayer or the taxpayer s authorized representative and am entitled to receive the result of this request. If you are a CPA or Attorney completing this Request for Statement of Good Standing for a business of which you are not a principle a principle of the business must ALSO sign this request as the taxpayer. If you are authorizing release of information for someone who is not a CPA or Attorney this form must be notarized* Taxpayer Signature Title Date Print Name Phone E-mail CPA/Attorney Signature Signature of person other than taxpayer CPA or attorney Form must be notarized. State of West Virginia County of to-wit This day appeared before me the undersigned notary public who acknowledge under oath the signature above. My commission expires If you would like the response faxed to you enter the fax number including area code. Name of person fax is to be addressed to Send this request to Excise Support Tax Unit 1st Floor PO Box 885 Charleston WV 25323-0885 Fax 304 558-8643 Phone Numbers 304 558-0678 304 558-8695 304 558-1114. Clear All Values GSR-01 Rev* 10/14 Print Your Return West Virginia Request for Statement of Good Standing State Tax Department Taxpayer Identification Number Complete Business Name Business Location Mailing Address Street City State Zip Type of business check one Partnership Sole Ownership Corporation/LLC Other I understand that in the event that this business is not in good standing with the Tax Department I will be notified in writing as to what tax returns or tax payments are considered not filed or paid and who to contact with any questions regarding that situation* By signing this Request for Statement of Good Standing I certify under penalty of perjury that I am the taxpayer or the taxpayer s authorized representative and am entitled to receive the result of this request. If you are a CPA or Attorney completing this Request for Statement of Good Standing for a business of which you are not a principle a principle of the business must ALSO sign this request as the taxpayer.