Application For Income Tax Refund Form - City Of North Ridgeville, Ohio (Page 2 of 2) in pdf

INSTRUCTIONS:

1. Copies of W-2 wage and tax statements must be attached otherwise application for refund

will not be accepted.

2. If refund claim is filed because all or portion of wages was earned while under 18 years of

age, please attach copy of birth certificate or driver’s license. (Copies returned upon request

if self addressed stamped envelope is provided)

3. If portion of wages was earned prior to 18 birthday submit breakdown (pay ending stub)

indicating amount. Employer certification is not required unless requested.

4. If refund claim is filed for a portion of wages earned in a non-taxing community, employer’s

certification setting forth in detail the amount of wages earned in the non-taxing community

must be completed.

5. Whenever it is necessary to have the claim executed by an agent on behalf of the taxpayer,

authenticated copy of the document specifically authoring such agent to sign the claim on

behalf of the taxpayer shall accompany the claim.

6. In all cases list the exact city of employment.

INSTRUCTIONS FOR EMPLOYER:

A. List total compensation paid and full amount of city tax withheld.

Compute the amount to be entered in “income earned in the city” by multiplying the total

compensation by the ratio of days worked in the city to total days worked. Days worked

only refers to the number of days on the job. An employee is on the job when there is a

holiday, or when he is sick or on vacation.

EXAMPLE: An employee worked 160 days in the city and 80 days out of the city, or a

total of 240 working days. Report as wages earned in the city, 160/240 or 2/3 rds of his

total wages (which would include vacation pay, holiday pay and sick pay) since all pay

has the same relative tax location as the location where the employee per-

forms his services.

NOTE: For employees paid on commission basis, the ratio of commissions earned in the

city to total commissions should be used instead of using days worked.

B. Basis for Refund: A brief but complete explanation by the employer is required concerning

reason for the overpayment to be refunded. Explain method and show computations used to

determine amount entered in the “income earned in the city.”

C. Show the employee’s address as listed on the employer’s records.

The Employer’s Certification/Computation must be signed by the employee’s supervisor or

other responsible representative of the employer who has knowledge that the information given

is true and correct.

NOTE: Separate requests are required if there is more than one employer or one city

involved.

Application For Income Tax Refund Form - City Of North Ridgeville, Ohio Page 2