Form Rf100 - Application For Refund - 2011 Page 4
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4FORM RF100-T
CALCULATION OF WAGES EARNED OUTSIDE OF THE JURISDICTION
PART III - Schedule of Days/Hours Spent Working Outside of the Jurisdiction
If additional space is needed, use photocopies of this page. Make sure you attach all pages to the refund form.
NOTE: a)
Schedule must be based upon actual working time. DO NOT use commissions, mileage etc.
b)
Any time spent working (preparing reports, making business related telephone calls, etc.) from your
Georgetown/Scott County home or office is considered time inside Georgetown/Scott County.
DATE
LOCATION
DAYS/HOURS
(a)
(b)
(c)
TOTAL this page
TOTAL other pages
GRAND TOTAL
Page 2
FORM RF100-T
Revised 10-2011
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