Form I-2 - Annual Federal Employee Occupational License Tax Return Page 2
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4COMPUTATION SHEET FOR INCOME EARNED OUTSIDE OF LOUISVILLE METRO, KY
Applies only if at least 5% of time worked was spent outside Louisville Metro, Kentucky
Please use the formula provided below in order to compute any deduction for wages earned outside of Louisville Metro,
Kentucky. Amount computed on Line E will be listed on Line 2 on front of this Form.
A
Number of days worked outside Louisville Metro, Kentucky
B
Total number of days worked (excluding holidays, vacation and sick days)
C
Percentage of days worked outside Louisville Metro, Kentucky (Divide A by B)
D
Total gross earnings (including deferred compensation and non-cash fringe benefits)
E
Income earned outside Louisville Metro, Kentucky (Multiply D by C)
NOTE: If you had earnings outside of Louisville Metro, Kentucky, you must retain the documentation to support your claim for
five (5) years as it is subject to review upon request.
NON-RESIDENT CERTIFICATION STATEMENT
I hereby certify that I have been a resident of _____________________________________________
(Street Address, City, County, State)
since _________________ and that this location is my permanent home and residence.
NON-RESIDENT MILITARY PERSONNEL CLAIMING EXEMPTION OF SERVICE PAY
I hereby certify that I am a non-resident, military personnel claiming exemption of my service pay from state and local
taxation under the Soldiers and Sailors Civil Relief Act. I have been a resident of
_____________________________________________ since _________________ and that this location is my permanent
(Street Address, City, County, State)
home and residence.
CERTIFICATION STATEMENT
I hereby certify that the information and statements contained herein and any schedules or exhibits attached are true and
correct.
________________________________________________________________
Date ______________________
Signature
Print Name ______________________________________________________
BE SURE TO SIGN AND DATE YOUR RETURN
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