Fillable Refund Request Form (Page 2 of 2) in pdf

GENERAL INSTRUCTIONS FOR REFUND REQUEST FORM

This form is for use by individuals claiming a refund of city tax withheld in excess of their liability. Indicate the calendar year for

which the refund is claimed. If the individual has other income, the standard city income tax return must also be used. If a refund

is claimed for tax withheld by more than one employer, a separate refund request must be completed for each employer. All forms

must be submitted together.

The completed form plus all attachments (W-2’s, computation worksheets, etc.) is to be submitted to the City of Troy Income Tax

Department at the address shown on the front of this form. Note: missing or incorrect information will delay your refund. Allow

90 days for the processing of this claim form.

1. BASIS FOR REFUND: A brief but complete explanation by the Applicant is required concerning the reason for the overpay-

ment. Explain method of calculation and show computations used to determine the amount of taxable city income. If job du-

ties require travel to different work sites to perform work, you must provide a list of dates and location of city or cities

worked. Seminars, meetings and training sessions, although they may be outside the city, do not constitute a change in work

situs and cannot be deducted as travel days. See Part C below for calculating travel day deduction.

2. Refund Calculation is based on your gross compensation (including any deferred income). A copy of the W-2 must be at-

tached.

3. The average working year consists of 260 days (Saturdays and Sundays are not typically considered working days). If you were

not employed for the full year, or were a part-time employee, or worked weekends, you must adjust your Total Days available

accordingly. Provide a written explanation and attach.

4. No refund of less than ten dollars ($10.00) will be made.

5. Refund requests will not be honored beyond three years from the date the original tax return was due.

6. Part B, Certification of Employer must be completed by an authorized official of the employer. No person claiming a refund

may certify their own refund request, or have the certification completed by a subordinate employee.

7. Please allow ninety days for the processing of your refund request.

Note: Incomplete claims cannot be approved or processed

and will be returned to the applicant.

PART C

To be completed only by non-residents claiming a refund of city tax withheld in excess of actual liability.

Compute the amount to be entered as taxable city income by multiplying the total compensation by the ratio of actual days

worked.

TOTAL DAYS AVAILABLE

________________

(260 standard, see instructions above for employment less than one full year)

LESS: VACATION DAYS TAKEN

__________________

LESS: SICK DAYS USED

__________________

LESS: HOLIDAYS DURING PERIOD

__________________

LESS: OTHER TYPES OF NON-WORKING DAYS __________________

TOTAL AVAILABLE WORKING DAYS (A minus B through E)

_________________

TOTAL AVAILABLE WORKING DAYS (F Above)

_________________

LESS: DAYS WORKED OUT OF TOWN (Attach Log)

_________________

DAYS ON THE JOB IN TROY (G minus H)

_________________

COMPUTATION:

_____________________ ÷ ___________________ X ___________________ = $______________________

Line I

Line F

Total Wages

Total Troy Taxable Income

Transfer the amount of Taxable City Income to Part A, Line A on the front of this form and complete calculations.

Refund Request Form Page 2

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