Form 211-T - Schedule Of Earnings Outside Of Fayette County

Form 211-T - Schedule Of Earnings Outside Of Fayette County - 2000 Page 2

SCHEDULE OF EARNINGS OUTSIDE OF FAYETTE COUNTY

PART I - General Information

State your name, social security number, job title, the period you were employed during the refund year and a brief explanation

of all the facts and circumstances surrounding your request for a refund of the license fee.

Name______________________________________________ Social Security # _____________________________

Job Title____________________________________________ Period From _____/_____/ 00 To ____/____/ 00

Total number of days in period __________________

(i.e. 1/1/00 to 12/31/00 = 366)

Explanation

PART II - Actual Method of Calculating Wages Earned Outside Fayette County

Complete PART IV, Columns (a) thru (d), and enter Column (d), Grand Total on Line 4 of Form 211-22, Application for Refund.

PART III - Percentage Method of Calculating Wages Earned Outside of Fayette County

Enter the “Total number of days in period” from PART I........................................................

Subtract:

a) Saturdays and Sundays (not worked)……………………..

b) Holidays (not worked)………………………………………

c) Sick days (not worked)…………………………………….

d) Vacation days (not worked) ……………………………….

Total days not worked (Add Lines 2a thru 2d)………………………………………………………

Total days worked on this job. (Subtract Line 2 “Total” from Line 1).........................................

Complete Part IV, Columns (a) thru (c). Enter total days worked outside of Fayette County,

from PART IV, Column (c), Grand Total................................................................................

Divide Line 4 by Line 3. (Carry result to four decimal places.) Enter the result here..............

Enter the amount from Line 1 of Form 211-22, Application for Refund..................................

Multiply Line 6 by Line 5. Enter the result here and on Line 4 of Form 211-22, Application for

Refund

Form 211-T, Revised 10-2000

FORM 211-T

SCHEDULE OF EARNINGS OUTSIDE OF FAYETTE COUNTY

Form 211-T - Schedule Of Earnings Outside Of Fayette County - 2000 Page 2