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Form NRR
Non-Resident Refund Application
For Days Worked Outside of Stow or
Taxes Over-withheld by Employer

Name Tax Year of Claim To avoid delays in your refund request, please return all
forms and documentation to the following address or
SSN Phone Number fax number:
City of Stow Tax Department
Current home address (number and street) Apt # P.O. Box 1668
Stow, OH 44224
City, state, and ZIP code Fax: 330-689-2847
Phone: 330-689-2849

Part I Reason for Refund Claim
Check the box that applies.
• A separate Form NRR is required if you have multiple W-2 forms.
• No refunds will be issued without the proper documentation indicated by reason for claim.

1 Days worked outside of Stow or at home in response to the COVID-19 pandemic for which the employer withheld Stow
tax. Attach a copy of your W-2 Form and complete both Part II - Calculation of Days Worked Outside of Stow and Part IV -
Employer Certification. Your employer must sign the Employer Certification.

2 Days worked outside of Stow or at home due to historical nature of work or services performed for which employer
withheld Stow tax. Attach a copy of your W-2 Form and complete both Part II - Calculation of Days Worked Outside of
Stow and Part IV - Employer Certification. Your employer must sign the Employer Certification. DO NOT USE FOR COVID-
19 RELATED REFUNDS.

3 Employer over-withheld Stow tax OR withheld Stow tax by mistake. Attach a copy of your W-2 Form and complete both
Part III - Calculation of Overpayment and Part IV - Employer Certification. Your employer must sign the Employer
Certification. DO NOT USE FOR COVID-19 RELATED REFUNDS.

4 Other (Indicate Reason). Attach W-2 Form and other applicable documentation and complete Part III - Calculation of
Overpayment and Part IV - Employer Certification. Your employer must sign the Employer Certification. DO NOT USE FOR
COVID-19 RELATED REFUNDS.

Reason:

Part V Claim Summary - Submit one claim per form. Please complete a separate Form NRR if multiple employers exist.
1 Employer Name 1 Employer Federal ID #

2 Amount of over-withheld tax from Part II Line 10
2
3 Amount of over-withheld tax from Part III Line 7
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Net amount to be refunded. Add Line 2 and Line 3. Amounts $10 or less will not be
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refunded. 4

Taxpayer's Signature
Under penalties of perjury, I declare that I have examined this claim, and to the best of my knowledge and belief, it is true, correct, and complete. I
understand that this information may be released to the tax administrator of my resident municipality and the Internal Revenue Service.

Taxpayer's Signature Date

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Name of employee shown on page 1 Employee SSN Tax Year of Claim

Part II Calculation of Days Worked Outside of Stow - Complete for Refund Claim Reason #1 or #2
A. Refund Calculation
Total workdays available. If you normally work a 5 day work week and you worked for your
employer for the entire year, enter 260 (52 weeks times 5 days). Otherwise, enter the
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number of days you normally worked in a week times the number of weeks worked (cannot
exceed 260). 1
Days not worked. Enter total number of days included on line 1 that you did not work due to
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holidays, personal days, sick days, and vacation days. 2
3 Total days actually worked. Subtract Line 2 from Line 1.
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Days worked outside of Stow for which Stow tax was withheld. A log of days must be
included (See B. Log of Days Out). For purposes of this refund claim, if you worked in another
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municipality that has an income tax, the wages earned in that municipality are subject to tax
in that municipality. Notification of this refund will be sent to the appropriate municipality.
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5 Days worked in Stow for which tax was withheld. Subtract Line 4 from Line 3.
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6 Percentage of wages earned in Stow. Divide Line 5 by Line 3.
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Total Stow taxable wages. For most taxpayers, this is the larger of Box 5 or Box 18 from your
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W-2. 7
8 Wages taxable to Stow for which tax was withheld. Multiply Line 6 by Line 7.
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9 Wages not taxable to Stow for which tax was withheld. Subtract Line 8 from Line 7.
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Amount of over withholding claimed. Multiply Line 9 by Stow's 2.00% rate for which tax was
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withheld. Enter here and on Part V Line 2 on page 1. 10

B. Log of Days Out
List the names of the municipalities where you worked while working outside of Stow and the number of days worked in those
municipalities. Your own worksheet is acceptable. Use additional paper if necessary. If you checked Refund Claim Reason #1 on
page 1, use COVID-19 as reason.

Travel Date(s) Work Location Reason Number of Days

Total number of days worked outside of Stow for which the employer withheld tax

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Name of employee shown on page 1                                       Employee SSN                       Tax Year of Claim

Part III   Calculation of Overpayment - Complete for Refund Claim Reason #3 or #4
A. Refund Calculation
         1 Total Wages from employee's W-2 Form (W-2 Box 5)
                                                                       1
         2 Amount of Stow tax withheld (W-2 Box 19)
                                                                                                         2
                                                                             Work location street address
           List the complete address of the physical location where 
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           employee performed the work or services.                          City, State, Zip Code
                                                                       3
           Enter the amount of municipal taxable wages actually earned 
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           within Stow                                                 4
         5 Stow tax rate                                                            2.00%
                                                                       5
         6 Tax due to Stow. Multiply Line 4 with Line 5
                                                                                                         6
           Amount of over-withheld tax to be refunded. Subtract Line 6 from Line 2. Amounts $10 or 
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           less will not be refunded or credited. Enter total here and on Part V Line 3 on page 1.       7

B. Employee's Home Address
The employee's home address for the period covered by this claim was:

Employee's Home Street Address                                         City, State, Zip Code

C. Employee's Employment Dates
If the employee is still employed, enter N/A as the date of separation.

                                     Date of Hire                      Date of Separation

Part IV    Employer Certification
A. Employer Representative's Explanation of Reason for Refund and Signature
The undersigned employer representative states that during the year referenced above, the employer withheld municipal 
income tax from the above named employee in excess of the employee's liability; that the above referenced employee was 
employed during the period referenced above; that the employer has examined this claim for refund in its entirety including any 
accompanying schedules and statements; and that the employer representative can attest that the information reported on this 
claim with respect to time worked in Stow is true and accurate.

In addition, the undersigned employer representative verifies that no portion of the over-withheld tax has been or will be 
refunded directly to the employee by the employer, and that no adjustments to the employer's withholding account related to 
this claim have been or will be made.

Representative's Signature                                             Title                              Date

Print Representative's Name                                            Phone Number

Explanation of Reason for Refund (example: taxpayer worked from home for X days")

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