Form Rf100 - Application For Refund - 2015
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42015
Mail return to:
Georgetown-Scott County
Form RF100
Revenue Commission
P.O. Box 800
APPLICATION FOR REFUND
Georgetown, KY 40324
APPLICANT’S SOCIAL SECURITY NO. ____________________________
NAME ___________________________________________________
EMPLOYED BY ___________________________________________________
ADDRESS____________________________________________________ ADDRESS
___________________________________________________
____________________________________________________
___________________________________________________
DAYTIME TELEPHONE NO. (__________)__________________________
___________________________________________________
______________________________________________________________________________________________________________________________
City of
Scott
Scott County
(INSTRUCTIONS ON BACK)
Georgetown
County
Schools
1.
TOTAL 2015 GROSS COMPENSATION, BEFORE ANY PRETAX
Attach W-2 (s) and any year end earnings
DEDUCTIONS --
summary statements reporting all wages and local license
fee withholding
................................................................................
2.
(Complete
WAGES EARNED OUTSIDE OF THE JURISDICTION...
Form RF100-T)
..For all refunds other than age 65 or over you
must complete all of Form RF100-T…………………………………
3.
ADJUSTED GROSS COMPENSATION…(Line 1 less Line 2).........
4.
IF YOU ARE 65 OR OVER DEDUCT $10,000…………………………
-
………….(DATE OF BIRTH
)...............................
MONTH - DAY - YEAR
5.
COMPENSATION SUBJECT TO LICENSE TAX (Deduct Line 4
from Line 3)........................................................................................
6.
LICENSE TAX WITHHELD FOR THE JURISDICTION......................
1%
1%
.5%
7.
LICENSE TAX RATE........................................................................
8.
LICENSE TAX DUE (Multiply Line 5 by Line 7).................................
9.
AMOUNT TO BE REFUNDED (Deduct Line 8 from Line 6)...............
Please allow 6-8 weeks for processing.
______________________________________________________________________________________________________________________________
I HEREBY CERTIFY THAT THE STATEMENTS MADE HEREIN AND IN ANY SUPPORTING SCHEDULES ARE TRUE, CORRECT AND COMPLETE TO
THE BEST OF MY KNOWLEDGE.
RETURN MUST
______________________________________________ BE SIGNED _______________________________________________
__________________
SIGNATURE OF INDIVIDUAL PREPARING RETURN
SIGNATURE OF APPLICANT
DATE
______________________________________________________________________________________________________________________________
Wages and License Tax verified by -________________________________________________________
_______________
DATE
Form RF100 (Rev. 10-12-15)
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