Form 211-T - Schedule Of Earnings Outside Of Fayette County - 2000 Page 3

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PART IV - Calculation of Days/Wages Earned Outside of Fayette County
If additional space is needed, use photocopies of this page. Make sure you attach all pages to the refund form.
NOTE: Any time spent working ( preparing reports, making business related telephone calls, etc.) from your Fayette County
home or office is considered time inside Fayette County.
DATE
LOCATION
HOURS/DAYS
WAGES
(a)
(b)
(c)
(d)
$
TOTAL this page
$
TOTAL other pages
$
GRAND TOTAL
$
Page 2
FORM 211-T
Revised 10-2000

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