Form Wcwt-5 - Application For Tax Payment / Tax Refund Of Wilmington Earned Income Tax - 2008 Page 4
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SECTION 3 - EMPLOYER CERTIFICATION
(CERTIFICATION REQUIRED FOR PROCESSING)
CERTIFICATION BY EMPLOYER: I certify that the facts shown above supporting Employee’s Claim for allocation and non-taxable
income are correct based on available payroll records.
FEI/FN
AUTHORIZED OFFICIAL (Type or Print)
TELEPHONE #
AUTHORIZED OFFICIAL (Signature)
TITLE
Questions
1. Did you file for 2007 Refund?
Yes
No
G
G
2. If Yes, have you since changed your address?
Yes
No
G
G
Signature/Identification
TAXPAYER SIGNATURE
DATE
SIGNATURE OF PREPARER OTHER THAN TAXPAYER
DATE
SOCIAL SECURITY NUMBER
NAME
ADDRESS
TELEPHONE NUMBER
IDENTIFYING NUMBER
SECTION 4 - PROCESSING - TAX OFFICE USE ONLY
A/P CLAIM
A/P CLAIM
WAGE
EMPLOYERS
REFUND AMOUNT
NUMBER
BATCH NUMBER
BATCH NUMBER
ACCOUNT NUMBER
PROCESSED BY
APPROVED BY - DIVISION HEAD
DEPARTMENT HEAD
APPROVAL (OVER $10,000)
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