OFFICE  USE 
                                                          APPLICATION 

                                                          FOR   REFUND 
 FOR  TAX                                                 City of Akron 
   YEAR 
                                                          INCOME   TAX 
_________                        (2106 Expense  or  Underage filers) 

Print  Name  &  Address  Below:                                                       Telephone Number 

                                                                                        Work ____________________________

                                                                                        Home ___________________________ 

                                                                                        SS#_________________________ _____

1. Enter total compensation received before any payroll deductions (attach copies of W-2’s) ………….  $ ___________________
       Print  Employer  Name               Dept Name or #        City Where Employed                      Work Location  (Address) 

  2.    2106  EXPENSES  - Attach Federal Form  1040 (pages 1 & 2                     ), Schedule 1, Form 2106, and copies of all W-2s.
     
  3.    UNDER  18 YEARS OF AGE  for the entire tax year … attach a copy of your driver’s license or 
       birth certificate  (BIRTH DATE MUST BE CLEARLY READABLE) 

We will calculate and issue a refund based on the information provided. 
Refunds are typically issued within 90 days after: i) the date the City has received a complete and accurate Refund 
Application, plus a copy of your employer’s complete and accurate AW-3 reconciliation form; or ii) April 15th of the 
year following the tax year at issue, whichever is later.
YOU MUST ATTACH COPIES OF W-2’S SHOWING AKRON WAGES AND AKRON INCOME TAXES WITHHELD. 

   If you were not assigned to the above employer’s Akron payroll for the entire year,  report the date you were assigned 
        to the Akron payroll and/or the date you were transferred out, and/or the date employment was terminated. 

(I worked in Akron from  _________________________  to  _________________________) 

I certify that I have examined this refund application, including any accompanying documents, and to the best of my 
knowledge and belief I attest that these documents represent a true and complete record of my taxable income to Akron. 

_______________________________________________                _______________________________________ 
Signature of Taxpayer                                                                                   Date

              Return completed form to:       Income Tax Division,  1 Cascade Plaza -   Suite 100,  Akron, OH 44308-1161

                                                                                                                                      2/2021