♦ 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 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.
♦ “To
tal Gross 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.
♦ “Job Related Expenses” (indicate the type and amount of each expense claimed on Line 2):
a) Unreimbursed business expenses incurred within the Urban County to the extent these expenses are deductible for federal
income tax purposes. You must attach a copy of Federal Form 2106 and Federal Form 1040, Schedule A.
b) Moving expenses incurred for a job related move into Fayette County to the extent these expenses are deductible for federal
income tax purposes. You must attach a copy of Federal Form 3903.
♦ 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) 258-3340
Email: Revenue@lexingtonky.gov
