The 763 S Virginia form is a document used by nonresidents to claim a refund of Virginia income tax withheld. This form is specifically designed for individuals who may qualify for exemptions based on their residency status or employment situation. Completing the form accurately can help ensure that taxpayers receive the refunds they are entitled to without unnecessary delays.
The 763 S Virginia form is an important document for individuals who have had Virginia state income tax withheld but are not residents of Virginia. This form allows nonresidents to claim a refund for taxes that may have been withheld in error or due to specific exemptions. Key aspects of the form include personal identification information, such as names, Social Security numbers, and addresses, which are essential for processing the claim. The form also requires filers to select an exemption category that accurately reflects their situation, such as commuting from another state, being a military spouse, or having taxes withheld mistakenly by an employer. Additionally, filers must provide details about the amount of tax withheld and may need to submit supporting documents, especially if claiming military spouse status. The form emphasizes the importance of accuracy and completeness, as missing information can lead to delays in receiving a refund. Understanding these elements is crucial for anyone navigating the complexities of state tax regulations while ensuring compliance and maximizing potential refunds.
763-S Virginia Special Nonresident Claim 2022
*VA763S122888*
For Individual Income Tax Withheld
First Name
MI
Last Name
Suffix
Your Social Security Number
Present Home Address (Number and Street, Including Apartment Number or Rural Route)
Spouse’s Social Security Number
City, Town or Post Office
State
ZIP Code
I (we) authorize the Department of Taxation to discuss my (our) return with my (our) preparer.
Amended Claim
Va. Dept. of Taxation 763S F 2601046 Rev. 06/22
Date of Birth
Your Birthday
-
Primary Taxpayer Deceased (Include Federal Form 1310 if
(MM-DD-YYYY)
applicable)
STEP I - Select Exemption Category
Review categories 1 - 4 below and enter the category number for which you are claiming an exemption.
1Commuter State Exemption: I declare that during the taxable year shown above I commuted on a daily basis from my place of residence to work in Virginia. My only income from sources within Virginia was from wages and salaries, which are subject to taxation by the state or district checked below. I did not live in nor was I a domiciliary or legal resident of Virginia at any time.
Check One:
District of Columbia
Kentucky
2Domiciliary State Exemption: I declare that during the taxable year shown above I was a domiciliary or legal resident of the state checked below. My only income from sources within Virginia was from wages and salaries, which are subject to taxation by the state checked below. I am not an actual resident of Virginia and I did not maintain a place of abode in Virginia for a total of more than 183 days.
Maryland
Pennsylvania
West Virginia
3Military Spouse Exemption: Complete the second page of this form first to provide information regarding your eligibility for this exemption. I declare that, for the entire portion of the taxable year I lived in Virginia, I was present in the state solely to be with my servicemember spouse who was on active military duty and in Virginia pursuant to military orders. To be exempt, either (1) you and your servicemember spouse must have the same non-Virginia domiciliary or legal state of residency or
(2) you must elect to use the same residence for purposes of taxation as that of your servicemember spouse. If you are claiming this exemption, enter the 2 letter state abbreviation for the domiciliary or legal state of residency of your servicemember spouse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4Tax Withheld in Error by Employer: I declare that during the taxable year shown above I was not a domiciliary or legal resident of Virginia at any time. I did not perform any services in Virginia and the Virginia tax was erroneously withheld from salary and wages paid to me by my employer.
Enter the 2 letter state abbreviation for your domiciliary or legal state of residency . . . . . . . . . . . .
STEP II - Enter amount of Virginia Tax withheld requested to be refunded:
If amended, enter the full refund amount as it should have been reported $ on the original return. You must provide copies of your withholding statements.
STEP III - Avoid delays: If you are a Resident of a State with an Individual Income Tax, enclose a complete copy of your State of Residence Income Tax Return and check this box.
If the Direct Deposit section below is not completed, your refund will be issued by check.
DIRECT BANK DEPOSIT
Your Bank Routing Transit Number
Account Number
Checking
Savings
Domestic Accounts Only
No International Deposits
Due by May 1, 2023. Mail to the Department of Taxation, P.O. Box 1498, Richmond, Virginia 23218-1498.
Both spouses must complete a separate Form 763-S when both filers have Virginia income tax withheld.
I, the undersigned, do declare under penalties provided by law that this is a true, correct and complete return.
Please
Your Signature
Date
Your Phone
Office Use
Sign Here
X
Preparer’s
Preparer’s Name
Preparer’s Phone Number
Use Only
Firm’s Name (or Yours if Self-employed) and Address
Preparer’s FEIN/PTIN/SSN
Code
Military Spouse Qualification
Complete each question below and provide copies of the requested documentation before claiming Exemption Category 3 on the front of this form. Incomplete responses or missing documentation could cause your refund to be delayed. The provisions of the Servicemember Civil Relief Act apply only to spouses of military servicemembers and do not apply to dependents.
I.Your spouse is a member of the armed forces present in Virginia in compliance with military orders.
1. Was your spouse in active military service for the taxable year in question?
Yes
No
a. If your spouse was discharged from full-time military service, what was
the date your spouse left the service?
_________________
MM/DD/YYYY
b.If your spouse was in the military at any time for the taxable year in question, provide his or her duty station(s) for the taxable year. Additional rows are provided in case your spouse had more than one duty station during the taxable year.
Location of Duty Station (include country if not USA)
Date Assignment Started
Date Assignment Ended
2. Where and when were you and your spouse married?
State ______________ _________________
3.Enclose a copy of your military ID card. This would be a military identification card issued to spouses of military personnel. If a military identification card has not been issued, check here.
4.What is your spouse’s state of domicile or legal state of residency? (Enter here and on Line 3 on
the first page of this return)
Enclose a copy of one or more of the following documents showing the military servicemember’s domicile or legal state of residency
(check the appropriate boxes to indicate which documents you are providing).
Leave & Earning Statement (LES) for the year in question
Current driver’s license from the military servicemember’s domicile state
DD Form 2058 (State of Legal Residence Certificate)
Other _______________________________________________________________________________
II.You are present in Virginia solely to be with your spouse.
5. Do you own a business or any income producing property in Virginia?
a.If yes, please describe. ___________________________________________________________________
III.You have the same non-Virginia domiciliary or legal state of residency as that of your servicemember spouse, or you elect to use the same non-Virginia state of residency as that of your servicemember spouse.
6.Did you file a state income tax return for the year in question with the state reported under question 4 above?
If you answered yes, enclose a copy of your state income tax return for the year in question. If your state of residency for tax purposes does not have an income tax, check here.
Note: A copy of documents requested above will assist the Department in speeding up the issuance of the refund.
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