Louisville Metro Revenue Commission 

           Annual Federal Employee 
                                                                                                           I-2_2018_V1.1D      Form 
           Occupational License Tax Return                                                                                          I-2

 CHECK IF CHANGE IN ADDRESS IS BELOW

Last name                               First name                                      MI                     Employer Account ID 
                                                                                                           (only if requesting a refund) 

Address (number and street)                                                   Unit/Apt. no.                    Your Account ID 
                                                                                                               (only if tax is due) 

City, town, or post office                         State                      Zip code                        Social Security Number 

Email                                              Phone no.                  Ext.                             Tax Year Ending 

Income       Applies only if at least 5% of time worked was spent outside Louisville Metro, KY. Please use the formula below to compute 
             any deduction for wages earned outside of Louisville Metro, KY.  
earned 
             A             Number of days worked outside Louisville Metro, KY                                  A 
Outside 
             B             Total number of days worked (excluding holidays, vacation, & sick days)             B 
Louisville 
             C             Percentage of days worked outside Louisville Metro, KY (Divide A by B)              C 
Metro, KY                                                                                                                                 %     
             D             Total gross earnings (including deferred compensation and non-cash fringe benefits) D          $                  .00 
             E             Income earned outside Louisville Metro, KY (Multiply D by C)                        E          $                  .00 
Wage         1.            Total gross wages per Box 5 or Box 18, whichever is greater on Federal Form W-2 
                           (including deferred compensation)                                                   1. 
Information                                                                                                               $                .00 
             2.            Salary, wages, and other compensation earned outside of Louisville Metro, KY 
                           (Line E)                                                                            2.         $               .00 
             3.            Salary, wages, and other compensation subject to occupational tax  
                           (Line 1 minus Line 2)                                                               3.         $               .00 
Occupational Amount of line 3 subject to each tax (See Instructions) 
                             Louisville Metro & Mass Transit (Line 3 x .0145)                      School Board (Line 3 x .0075) 
Tax                                                                                                Louisville Metro Residents Only 
Calculations 4.            A $                                           .00         B  $                                                    .00 
Tax Due      5.            Tax Due (Residents: Line 4a + 4b, Non-Residents: Line 4a)                           5.         $                 .00 
Calculations 6.            Amount withheld by employer or prepaid                                              6.         $                .00 
             7.            Balance Due (Line 5 - Line 6)                                                       7.         $                 .00 
             8.            Penalty & Interest (see instructions)                                               8.         $                 .00 
             9.            Total Amount Due (Line 7 + Line 8)                                                  9.         $                  .00 
             10.           Overpayment to be refunded (If Line 6 > Line 5)                                     10.        $                 .00 
Non-Resident Must be completed if claiming refund as a non-resident of Louisville, Metro KY. 
             I hereby certify that the address listed below is my permanent home and residence. 
Statement 
             Address (number and street)                                                                                            Unit /Apt. no. 

             City                                             State                     Zip Code                          Since when 

                              MAILING ADDRESS: P.O. BOX 32060, LOUISVILLE, KENTUCKY 40232-2060 
                                                         Telephone: (502) 574-4860  

Non-Resident  I hereby certify that I am a non-resident, military personnel claiming exemption of my service pay from state and local 
              taxation under the Soldiers and Sailors Civil Relief Act. The address listed below is my permanent home and residence. 
military      Address (number and street)                                                             Unit /Apt. no. 
personnel  
              City                        State     Zip Code                               Since When 

Certification I hereby certify that the information and statements contained herein and any schedules or exhibits attached are true and 
              correct. 
Statement     Applicant Signature                                                          Date 

              Print Name 

                                          IMPORTANT 

ELECTRONIC FILING: Register for electronic filing. It is an easy, secure, and convenient way to file and pay taxes on-line. For more information log on to 
                                          https://www.metrorevenueservices.org 
         Mail Form I-2, along with a copy of Form W-2. If form W-2 is not attached to this tax return a delay will occur if requesting a refund. 

                          MAILING ADDRESS: P.O. BOX 32060, LOUISVILLE, KENTUCKY 40232-2060 
                                          Telephone: (502) 574-4860