Application For Refund Jedd Income Tax - Akron, Oh
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1OFFICE USE
SELECT JEDD
APPLICATION
BATH-AKRON-FAIRLAWN
FOR REFUND
FOR TAX
COPLEY-AKRON
JEDD INCOME TAX
YEAR
COVENTRY-AKRON
SPRINGFIELD-AKRON
(2106 Expense or Underage filers)
_________
Print Name & Address Below:
Telephone Number
Work ____________________________
Home ___________________________
SS# ______________________________
1. Enter total compensation received before any payroll deductions (attach copies of W-2’s) …………. $ ___________________
Print Employer Name
Dept Name or #
City Where Employed
Work Location (Address)
2.
2106 EXPENSES - Attach a copy of your Federal 1040 (pages 1 & 2), FORM 2106, SCHEDULE A and
copies of all W-2s.
3.
UNDER 18 YEARS OF AGE for the entire tax year … attach a copy of your driver’s license or
birth certificate (BIRTH DATE MUST BE CLEARLY READABLE)
We will calculate and issue a refund based on the information provided.
Payment will be made within 90 days or receipt of the completed refund request or
completed employer annual withholding return, whichever is later.
YOU MUST ATTACH COPIES OF W-2’S SHOWING JEDD WAGES AND JEDD INCOME TAXES WITHHELD.
If you were not assigned to the above employer’s JEDD payroll for the entire year, report the date you were assigned
to the JEDD payroll and/or the date you were transferred out, and/or the date employment was terminated.
(I worked in the JEDD from _________________________ to _________________________)
I certify that I have examined this refund application, including any accompanying documents, and to the best of my
knowledge and belief I attest that these documents represent a true and complete record of my taxable income to the JEDD.
_______________________________________________
_______________________________________
Signature of Taxpayer
Date
Return completed form to : JEDD INCOME TAX, PO Box 80538, Akron, OH 44308
(330) 375-2539
1/2008
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