Fayette County Public Schools 
                                                Claim for Refund of Overpayment of 
                                       Occupational License Tax Withheld for Schools 

  Name                                          Address  
   
  City                          State                     Zip                                        County  
   
  Social Security Number                                                          Phone Number  

  Employed By 

  Employer’s Federal ID  Number 
                                                                                                     OFFICE USE ONLY 

  Employer’s Account Number                                                                          Vendor Number 

                                                                                                                      OFFICE USE ONLY 
TAX YEAR 

1  Number of days/hours in period less Saturdays and Sundays not worked …….. 
2  Number of days/hours worked outside of Lexington, Kentucky.………………….. 
3  Percentage of time worked outside Lexington, Kentucky (Divide Line 2 by Line 1).. 
4  Total gross wages (prior to any deductions) per W-2 form ……………………….. 
5  Total wages worked outside of Lexington, Kentucky (Multiply Line 4  by Line 3).. 
6  Local taxable wages (Subtract Line 5 from Line 4)………………………………... 
7  Occupational License Tax Withheld per W-2 Form.………………………………. 
8  Occupational License Tax due (Multiply Line 6 by .005)………………………….. 
9  Amount of overpayment to be refunded (Subtract Line 8 from Line 7)…………... 

   EXPLANATION FOR REFUND: 
    
   Occupational taxes withheld from wages of employee for time worked outside of Lexington, Kentucky (Attach a listing 
   including specific dates and places worked outside Lexington, Kentucky, along with a copy of W-2 form). 
    
           Working Period From                  20         To                       20 
    
   Occupational taxes withheld on wages of employee who did not reside in Lexington, Kentucky (Attach a copy of W-2 
   form).  

            Current Residence                                  Since - Date 

I hereby certify that the statements made herein and in any supporting schedules are true, correct, and complete to the best of my knowledge. 

           APPLICANT SIGNATURE                            DATE                                       EMPLOYER PHONE NUMBER        

    AUTHORIZED EMPLOYER SIGNATURE                         DATE                                       PRINTED EMPLOYER NAME/TITLE 
    CERTIFYING INFORMATION   IS CORRECT 

                                RETURN MUST BE SIGNED BY EMPLOYER                               AND APPLICANT              Form FOL-7 
                                                                                                                           Revised 12/12 

REQUIRED NFORMATION I   
 
 Separate application needed for each tax year. If employee worked for two different employers  
      during the year, an application is needed for each employer for each tax year. 
 Form must be submitted with an original signature. A copy of W-2 Form must accompany each   
   refund request showing federal taxable, social security and Medicare wages, and local tax withheld. 

INSTRUCTIONS FOR PREPARING THE REFUND APPLICATION   

Section I.  Enter employee name, complete address, social security number, phone number, employer, 
employer’s Federal ID number (will be on W-2) and employer’s local account number, if known. 

Section 2. Enter the year for which the refund request is submitted.  

   Line 1  Enter the total number of days/hours in period less Saturdays & Sundays not worked (i.e. 5 
            days a week X 52 weeks per year = 260 days/ 40 hours X 52 weeks per year = 2080 hours) 

   Line 2  Enter the total number of days/hours worked outside of Lexington, Kentucky  

   Line 3  Divide Line 2 by Line 1 to figure the percentage of time worked outside of Lexington,     
            Kentucky 

   Line 4  Enter the total gross wages per W-2 Form before any deductions. Includes but not limited to 
            income from salaries, wages, commissions, bonuses, severance and/or termination pay, 
            deferred compensation and/or pension plans, cafeteria plans, vacation, sick leave and paid 
            holidays, etc. 

   Line 5  Multiply Line 4 by Line 3 to figure total wages worked outside of Lexington, Kentucky  

   Line 6  Subtract Line 5 from Line 4 and this is the local taxable wages 

   Line 7  Enter the total tax withheld for schools from your W-2 Form 

   Line 8  Multiply Line 6 by .005 to figure Occupational License Tax due  

   Line 9  Subtract Line 8 from Line 7. This is the amount to be refunded 

Check the appropriate box under Explanation for Refund. If refund is requested for non-residency, enter 
current residence and how long you have lived at that residence. Also, enter the dates of the working 
period.  

Section 3. The Employee and Employer must provide a signature for the refund application to be  
processed. The employer signature must be a person of authority and must certify that the information 
provided is true and correct. 

GENERAL INFORMATION    
 
 THERE     IS A TWO-YEAR STATUTE OF LIMITATIONS  within which a refund request must be submitted to 
   the Fayette County Public Schools. The refund request must be postmarked within two years from 
   the due date of the Annual Reconciliation Return and W-2s. Due date for these documents is      
   February 28.  
 Please allow six to eight weeks processing time starting from March 15.  
 Failure to complete any or all parts of this form will delay the processing of your refund and may re-
   sult in your refund application being returned to you. 

MAILING ADDRESS:  
 
Tax Collection Office · Fayette County Public Schools · P.O. Box 55570 · Lexington, Kentucky   40555-5570