Form E-1r - Individual Earnings Tax Return - City Of St. Louis - 2010 Page 2
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1
2IMPORTANT INFORMATION
• The Form (E-1R) is to be used by non-residents who are requesting a refund based on days worked outside the City of St. Louis. Generally, a resident of
the City of St. Louis is not eligible for a refund.
• Annual leave, sick leave, and/or separation pay of any person who terminates or is separated from a place of employment located within the city is taxable
in the year received, regardless of when or where earned, and regardless of where recipient lives.
• Stocks not represented on Form(s) W-2 will need documentation from employer.
• A copy of mortgage deed or lease is required for verification of dates moved in or out of the City of St. Louis.
• Refunds are issued approximately 4 to 6 weeks after receipt of all documentation. Refund claims must be filed within one year of due date. Per I.R.S., a
Form 1099-G will be issued to all taxpayers receiving a refund.
• This return is to be filed with Gregory F.X. Daly, Collector of Revenue, Earnings Tax Dept., 410 City Hall, 1200 Market St., St. Louis, Missouri
th
63103-2841, on or before April 15
of the following year.
INSTRUCTIONS FOR REVERSE SIDE
Joint returns are not permitted.
1.
List all Federal Form(s) W-2. Enter total gross wages as shown in Box 1 of Form W-2, (less any income derived from stock options). Attach W-2
forms and statements regarding stock options.
2.
Total gross wages of all W-2 forms received. Add lines A, B, C & D.
3.
Non-resident deduction (non-residency formula below must be completed).
4.
Subtract line 3 from line 2.
5.
Earnings Tax (line 4 x 1%).
6.
Total City Earnings Tax withheld as shown in box 19 from all Form(s) W-2.
7.
Refund Due (subtract line 5 from line 6). No refund issued less than $1.00.
8.
Send completed Form E-1R, with required documentation, to Gregory F.X. Daly, Collector of Revenue, Earnings Tax Dept., 410 City Hall, 1200
th
Market St., St. Louis, MO 63103-2841, on or before April 15
of the following year.
EMPLOYER VERIFICATION SECTION
THIS SECTION MUST BE COMPLETED BY THE EMPLOYER
If a taxpayer is claiming a non-residency deduction on Form E-1R, the following verification must be completed by the appropriate managerial personnel.
According to City of St. Louis Code Section 5.22.040 Non-Resident Individual; only full days worked out of the city are eligible for refunds to non-resident
employees. Employees who start and/or finish their work day in the city are not allowed to use that day as a day worked out of the city.
S S treckfus Steamers Inc. v. City of St. Louis. 472 S.W. 2d 660.
This is to certify the below mentioned employee, a non-resident of the City of St. Louis, worked a total of _________ days including vacation,
sick, and holidays everywhere.
This is to certify the below mentioned employee, a non-resident of the City of St. Louis, worked outside the City of St.Louis a total
of __________ whole days.
The standard work year is 260 days. If the employee worked more or less than 260 days or moved in or out of the City of St. Louis during the year,
an explanation must be provided on the below lines (attach separate sheet if additional space is needed).
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
I certify, to the best of my knowledge, that the above information is true and accurate, and the records are available to verify this information.
Please complete the following information:
THE BELOW AREA FOR POST OFFICE USE ONLY
Employee Name: _______________________________________________
The “Official Post Office Branch Date Stamp” must be
placed below for Postal Employees requesting a refund.
Company Name: _______________________________________________
Company Address: _____________________________________________
Company Phone Number: _______________________________________
Printed Name of Supervisor/Manager: _____________________________
Signature: _____________________________________________________
Title: _________________________________________________________
NON-RESIDENCY DEDUCTION FORMULA
THIS SECTION MUST BE COMPLETED TO CLAIM A NON-RESIDENT DEDUCTION
. 1
A
c
u t
l a
a d
s y
w
o
k r
d e
e
e v
y r
w
e h
. e r
_ _
_ _
_ _
_ _
_ _
a d
s y
(STANDARD WORK YEAR IS 260 DAYS)
2. Actual whole days worked outside the city per employer verification.
__________ days
3. Percentage of days worked outside the city (line 2 ÷ line 1).
__________ %
4. Gross wage per Fede
r
l a
F
r o
m (s) W-2.
$
_ _
_ _
_ _
_ _
_ _
. 5
N
n o
r -
s e
d i
n e
y c
e d
u d
i t c
n o
i l (
e n
4
x
i l
e n
3
. )
_ _
_ _
_ _
_ _
_ _
Enter line 5 results on reverse side, on line 3, for non-residency deduction.
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