VA-5

Form VA-5 - Employer's Return of Virginia Income Tax Withheld (Monthly)

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VA-5

For Monthly Period

Month

Year

Account Number

30-

FEIN

F-

Account Suffix

Demographics

Business Name

Mailing Address

City

State

ZIP

VA-5

1. VA Income Tax Withheld

2. Previous Period(s) Adjustment

3. Adjustment Total

4. Penalty

5. Interest

6. Total Amount Due

Check if this is an amended return.

Payment

Please enter your payment details below.

If your bank requires authorization for the Department of Taxation to debit a payment from your checking account, you must provide them with this Debit Filter number: 1546001745

At present, Virginia TAX does not support International ACH Transactions (IAT). Click IAT Notice to review the details.

Please note, a $35 fee may be assessed if your payment is declined by your financial institution as authorized by Code of Virginia §2.2-614.1. Visit our website for more information.

Bank Account Information

Bank Routing Number

Bank Name

Bank Account Number

Re-Enter Bank Account Number

Payment Information

Payment Amount

Payment Date Today

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Payment Information

Bank Routing Number

Bank Account Number

Payment Amount

Payment Date Once confirmed this date cannot be modified

Electronic Signature (required)

I, the undersigned president, vice-president, treasurer, assistant treasurer, chief accounting officer, owner, or other officer duly authorized to act, of the corporation for which this return is made, declare under the penalties provided by law that this return (including any accompanying schedules and statements) has been examined by me and is, to the best of my knowledge and belief, a true, correct, and complete return, made in good faith, for the taxable year stated, pursuant to the income tax laws of the Commonwealth of Virginia. If prepared by a person other than taxpayer, their declaration is based on all information of which they have any knowledge.

Your Name

Your Title

Other Title

Phone Number

Tax Preparer Authorization (optional)

By checking the box to the left, I (we) authorize the Virginia Department of Taxation to discuss this return with the undersigned Tax Preparer.

Are you the Tax Preparer?

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Phone Number

Preparer FEIN/TIN

Preparer Name

Email Confirmation (optional)

If you wish to receive a copy of the confirmation PDF, enter your email address below. This is optional and is provided as a backup if you cannot open/save the PDF on the next page. Entering your email address permits the Virginia Department of Taxation to email you the confirmation PDF for this transaction, which contains return and payment details.

The Department of Taxation discourages using non-business email addresses or shared mailboxes. Do not share this email or the contents therein with unauthorized persons. The Department of Taxation does not assume responsibility if an incorrect email address is entered.

Email Address

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Form VA-5 - Employer's Return of Virginia Income Tax Withheld (Monthly)

VA-5

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