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INSTRUCTIONS FOR EMPLOYEE REFUND OF OCCUPATIONAL TAXES WITHHELD

GENERAL INSTRUCTIONS:

Refund procedures have changed. We require the number of hours worked to be reported. The normal work year is 2080 hours. We do realize that many jobs require

overtime and the overtime rate differs from the regular hourly rate. In this case, the employee may need to complete a different formula using the overtime rate. It is

IMPERATIVE that the refund application be completed as required in the instructions below. If it is completed incorrectly, it will be returned to the applicant, which will

delay the refund.

FOR PAYROLL WITHHOLDING REFUND APPLICATIONS:

The employee can complete the application, but the EMPLOYER must sign the refund application and verify that all information on the document is correct. THE

REFUND CHECK WILL BE MAILED DIRECTLY TO THE EMPLOYEE AT THE ADDRESS PROVIDED ON THE APPLICATION. If the address is incorrect, the check will

be retuned to our agency. The employee is required to complete the appropriate areas on the request and sign the form or the request will not be honored. It takes

approximately 6 to 8 weeks to process refund requests.

REQUIRED INFORMATION NEEDED FOR PAYROLL WITHHOLDING REFUND REQUESTS:



Separate application for each employee for each year and each locality involved.



Copy of W-2 issued for each year and each locality involved. If the W-2 is not available, a copy of the last check stub with year to date totals will suffice. Current

year withholding must also be verified. A computer printout from payroll office will also suffice.



Signature by EMPLOYEE AND EMPLOYER.

INSTRUCTIONS FOR PREPARATION OF REFUND APPLICATION:

LINE 1.

Enter name of Refund Applicant.

LINE 2.

Enter mailing address of Refund Applicant.

LINE 3.

Enter city, state and zip code for Line 2 address.

LINE 4.

Enter tax year for refund.

LINE 5.

Enter refund amount, as calculated on Line 22 (YOU MAY ROUND TO WHOLE DOLLARS).

LINE 6.

Enter applicant city of residence

LINE 7.

Enter name of employer

LINE 8.

Enter applicant city of employment

LINE 9.

Enter employer’s Federal ID number or Social Security Number

LINE 10. Employer or Business Occupational License Account Number.

LINE 11. Check locality for which refund is claimed. YOU MUST SUBMIT A SEPARATE FORM FOR EACH REFUND LOCALITY.

LINE 12. Check the appropriate item that describes the reason a refund is claimed

Lines 13 to 22 must be completed by employees requesting refunds for work performed outside the locality checked on Line 11.

LINE 13. List all localities with the number of hours worked. Check ALL applicable Quarters for which any portion of refund was withheld.

LINE 14. Enter number of hours worked outside of Locality checked on Line 11.

LINE 15. Enter total number of hours worked excluding Holiday, vacation and sick days. Normal work year = 2080 hours.

LINE 16. Enter percent of time worked outside Locality checked on Line 11 -- divide Line 14 by Line 15.

LINE 17. Enter total gross wages including deferred compensation per W-2 Form (Box 5 or Box 18, whichever is greater)

LINE 18. Enter total wages earned outside Locality on Line 11 -- multiply Line 16 X Line 17.

LINE 19. Enter local taxable wages -- Subtract Line 17 – Line 18.

LINE 20. Enter occupational tax due – multiply Line 19 X applicable rate -- see Tax Rate Table (available on website

or by calling

office)

LINE 21. Enter amount of tax withheld per W-2 Form or year to date payroll stub -- submit copy with application.

LINE 22. Enter amount of refund requested – if Line 21 is greater than Line 20, subtract Line 21 – Line 20

IMPORTANT:

EMPLOYEE SIGNATURE: Must be provided

EMPLOYER’S AUTHORIZED SIGNATURE: Person signing must be in a position of authority for payroll such as corporate officer, chief accountant or payroll manager

and must certify that the information provided is true and correct.

TAX RATE TABLES

FOR TAX YEAR WAGE “CAPS” AND MAXIMUM TAX REFER TO TAX TABLES

ON WEBSITE

For assistance, contact Campbell County Fiscal Court, Occupational License Dept., 1098 Monmouth St., Newport, Kentucky,

Phone: 859-292-3884. Hours: Mon. to Fri. 8:30 a.m. - 4:15 p.m.

Website: