Occupation Tax Refund Form - City Of Pittsburgh Department Of Finance printable pdf download

CITY OF PITTSBURGH

DEPARTMENT OF FINANCE

OCCUPATION TAX REFUND FORM

Attach a COPY of the OT-2 receipt given to you by your first employer.

Attach the ORIGINAL OT-2 receipt given to you by your second employer.

Attach a copy of the OT-2 receipt given to you by any other employer(s).

Pay stub/statements (that clearly show the employer name), or a letter from your employer(s) on

company letterhead will be accepted as proof of payment if the OT-2 receipt is unavailable.

CHECK ONE –

IF FORM IS NOT COMPLETED CORRECTLY YOUR REQUEST COULD BE DENIED.

Multiple payment. Enter names of employers in the blocks below.

_____

Enclose 1 original and 1 copy of receipt showing duplicate payment of the tax.

_____ Gross earnings for the tax year were under $1,000.00. Enclose copies of your W-2(s) and

Federal 1040 form from all employers for year(s) in question, including joint returns.

_____ Self-employed, your City ID number ________________________________

_____ Paid directly to the City under your Social Security number ______________using Form OT-3.

_____ Employer refund, enclose copy of your cancelled check (front and back) include your City

ID number. Attach letter of explanation.

_____ Not liable:

_____ High School Student at ______________________school.

_____ Liable to _________________________________Municipality.

Enclose evidence of deduction certificate from this municipality.

EMPLOYER NAME

EMPLOYER FEDERAL ID #

EMPLOYER PHONE NUMBER

COMPLETE A SEPARATE FORM FOR EACH YEAR REQUESTED

SOCIAL SECURITY NUMBER

________________________

YEAR __________ DATE __________

I hereby certify, swear and aver that all statements herein are true and correct to the best of my knowledge and belief,

being duly appraised of my duty under the law to submit honest and complete information or be subject to the penalties

provided by law.

SIGNATURE __________________________________

PHONE ________________________

ADDRESS _______________________________________________________________________

CITY/STATE/ZIP __________________________________________________________________

Return 2 copies – Keep 1 copy for your records. Questions call 412-255-8629 or 255-2510.

Mail to: CITY OF PITTSBURGH – DEPARTMENT OF FINANCE – 414 GRANT ST RM 207 – PITTSBURGH PA 15219

Occupation Tax Refund Form - City Of Pittsburgh Department Of Finance