Claim For Refund Form - City Of Louisville, Ohio Page 2
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2CITY INCOME TAX REFUND CALCULATION
NON-RESIDENT FORMULA
Name _________________________________________________ Social Security # ________________________________
Days worked out ____________ Total Salary $ ________________ Amount Withheld $ ______________
Vacation Days ___________ (+)Holiday Days ___________ (+)Sick Leave Days __________ (=) (1)Days ___________
Do not include days worked out
260 Days Less (1) ___________ = (2) ___________ Days Worked
$ __________ ÷ (2) __________ = (3)$ __________ Average Rate Per Day Worked
(2) __________ Less __________ Days Worked Out = (4) __________ Days Worked In Louisville
(4) __________ x (3) __________ = (5)$ ___________ Taxable Wages For Louisville
(5)$ __________ x 2% = (6) __________ Tax Due
$ __________ Withheld Less (6) ___________ = Refund Due $ __________ (Enter on Line 5 of Claim For Refund Form)
Remarks:
*Exception (example )
If employer withheld lower than 2% of withholding and paid this portion to City of Louisville, the lower rate will be refunded.
Please Note: You must attach a schedule of dates and locations worked out of the City of Louisville
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