Fillable Form 211-22: APPLICATION FOR REFUND (Lexington-Fayette Urban County Government)

Fill Online, Printable, Fillable, Blank Form 211-22: APPLICATION FOR REFUND (Lexington-Fayette Urban County Government) Form

Use Fill to complete blank online LEXINGTON-FAYETTE URBAN COUNTY GOVERNMENT (KY) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Form 211-22: APPLICATION FOR REFUND (Lexington-Fayette Urban County Government)

On average this form takes 24 minutes to complete

The Form 211-22: APPLICATION FOR REFUND (Lexington-Fayette Urban County Government) form is 4 pages long and contains:

  • 0 signatures
  • 0 check-boxes
  • 97 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Lexington-Fayette Urban County Government

BROWSE LEXINGTON-FAYETTE URBAN COUNTY GOVERNMENT (KY) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
2019
Form 211-22
APPLICATION FOR REFUND
****REFUND PROCESSING WILL BEGIN AFTER
MARCH 15, 2020****
Please allow 6-8 weeks for processing
EMPLOYED BY_______________________________________________
ADDRESS _________________________________________________
APPLICANT’S SOC. SEC. LAST 4 & DATE OF BIRTH ________________
NAME________________________________________________________
ADDRESS____________________________________________________
__________________________________________________
_____________________________________________________
DAYTIME TELEPHONE NO. (__________)__________________________ EMAIL ADDRESS ____________________________________________
___________________________________________________________________________________________________________________________
(INSTRUCTIONS ON BACK)
FOR OFFICE USE
ONLY
1.
TOTAL 2019 GROSS COMPENSATION, BEFORE ANY PRETAX DEDUCTIONS
Attach W-2 (s) and any year end earnings summary statements reporting all
wages and local license fee withholding...................................................................
2.
3.
4.
WAGES EARNED OUTSIDE OF FAYETTE COUNTY...
(Complete Form 211-T)....
For all refunds other than age 65 or over you must complete all parts of Form 211-T…
5.
ADJUSTED GROSS COMPENSATION (Deduct Line 2 from Line 1).............................
6.
IF YOU ARE 65 OR OVER DEDUCT $3,000.(DATE OF BIRTH
-
_____ - _____- ____
)...
7.
COMPENSATION SUBJECT TO LICENSE FEE (Deduct Line 4 from Line 3)...............
8.
LICENSE FEE WITHHELD FOR THE URBAN COUNTY GOVERNMENT...................
LICENSE FEE DUE (Multiply Line 5 by 2.25%)................................................................
AMOUNT TO BE REFUNDED (Deduct Line 7 from Line 6)..........................................
Please allow 6-8 weeks for processing.
______________________________________________________________________________________________________________________________
I HEREBY CERTIFY THAT THE STATEMENTS MADE HEREIN AND IN ANY SUPPORTING SCHEDULES ARE TRUE, CORRECT AND COMPLETE TO
THE BEST OF MY KNOWLEDGE.
RETURN MUST
______________________________________________ BE SIGNED _______________________________________________ __________________
SIGNATURE OF INDIVIDUAL PREPARING RETURN SIGNATURE OF APPLICANT DATE
___________________________________________________________ ____________________________________________________________
AUTHORIZED EMPLOYER SIGNATURE CERTIFYING INFORMATION IS CORRECT PRINTED NAME
______________________________________________ _________________________ _________________________________________________
TITLE
PHONE NUMBER DATE
______________________________________________________________________________________________________________________________
Form 211-22 (Rev. 1-2020)
OFFICE USE ONLY
VCH# _____________________
% IN _____________________
ACCT# _____________________
______________ ____________
INITIA
LS DATE
______________ ____________
INITIALS DATE
(Valid until Feb. 28, 2022)
2019 REFUND
INSTRUCTIONS ♦♦♦♦
♦ The Employee and Employer must provide a signature for the refund application to be processed. The person signing this form for the
Employer must be in a position of authority and must certify that the information provided on this statement is true and correct. The
applicant may not certify their own information.
♦
Form 211-22, Application for Refund must be submitted with original signatures and dated. No photocopied or emailed
signatures will be accepted. Also, W-2 forms submitted must show federal taxable, social security and medicare wages (not just
local wages) and the 2.25% license fee withheld. Also, attach a copy of any year end earnings summary statements.
♦ Failure to complete any or all parts of Form 211-T will delay the processing of your refund and may result in your refund application
being returned to you.
♦ “Total Gro
ss Compensation” includes income from salaries, wages, bonuses, severance and/or termination pay, deferred
compensations and/or pension plans, cafeteria plans, etc. and amounts received for approved leave including, but not limited to,
vacation, sick or holiday pay. This is generally found inbox 18 of the W-2 form.
NOTE: If a refund is claimed for wages earned outside of Fayette County and the wages are from more than one employer, a
separate application must be completed for each employer.
♦ For individuals 65 years of age and older, the first $3,000.00 of compensation earned in a given year is exempt. The exemption is not
for the $3,000.00 of compensation received from each employer during a given year. To qualify for this exemption you must enter
your date of birth in the space provided. Also, you must attach a copy of all Federal Form W-2s received for the year.
♦ If Line 10 is negative, this indicates any amount due. Contact this office for instructions on remitting the underpayment.
Mail return: Lexington-Fayette Urban
County Government
Division of Revenue
P.O. Box 14058
Lexington KY 40512
Phone: (859)258-33
40
Email: Revenue@lexingtonky.gov
FORM 211-T
CALCULATION OF WAGES EARNED OUTSIDE OF FAYETTE COUNTY
IMPORTANT - Failure to complete any or all parts of Form 211-T will delay the processing of your refund and may
result in your refund application being returned to you.
PART I - General Information
State your
name, social security number, job title, the period you were employed during the refund year and a brief explanation of all the
facts and circumstances surrounding your request for a refund of the license fee.
Name______________________________________________
Social Sec. Last 4 & Date of Birth___________________________
Job Title____________________________________________
Period From _____/_____/ 19 To ____/____/19
Total number of days or hours in period __________________
(i.e. 1/1/19 to 12/31/19 = 365)
Explanation of work performed outside of Fayette County
PART II - Wages Earned Outside of Fayette County
Enter the “Total number of days or hours in period” from PART I.................................................
Subtract days or hours not worked:
a) Saturdays and Sundays (not worked)……………………..
b) Holidays (not worked)………………………………………
c) Sick days or hours (not worked)…………….……………….
d) Vacation days or hours (not worked) …….……….………….
Total days or hours not worked (Add Lines 2a thru 2d)……………….……………………………
Total days or hours worked on this job. (Subtract Line 2 “Total” from Line 1)..............................
Complete Part III, Columns (a) thru (c). Enter total days or hours worked outside of Fayette County,
from PART III, Column (c), Grand Total...........................................................
Divide Line 4 by Line 3. (Carry result to four decimal places.) Enter the result here..............
Enter the amount from Line 1 of Form 211-22, Application for Refund..................................
$
Multiply Line 6 by Line 5. Enter the result here and on Line 2 of Form 211-22, Application
for Refund
$
Form 211-T, Revised 1-2020
FORM 211-T
CALCULATION OF WAGES EARNED OUTSIDE OF FAYETTE COUNTY
PART III - Schedule of Days or Hours Spent Working Outside of Fayette County
If additional space is needed, use photocopies of this page. Make sure you attach all pages to the refund form.
♦ Schedule must be based upon actual working time. DO NOT use commissions, mileage etc.
♦ Any time spent working (preparing reports, making business related telephone calls, etc.) from your
Fayette County home or office is considered time inside Fayette County.
♦ If you worked from home in another Kentucky jurisdiction, you may owe the Occupational tax to that
jurisdiction.
♦ The information contained in the application may be shared with other taxing jurisdictions.
♦ You MUST provide the location where work outside the county was performed
DATE
(a)
LOCATION
(b)
DAYS or HOURS
(c)
TOTAL this page
TOTAL other pages
GRAND TOTAL
FORM 211-T, Revised 1-2020
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Form 211-22: APPLICATION FOR REFUND (Lexington-Fayette Urban County Government)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 3 August 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document