Louisville Metro Revenue Commission 
                                                                                      Do Not Duplex Form
                Application for Employee Refund of 
                                                                                                       W1REE_2018_V1.0
                Occupational Taxes Withheld 
                                                                                                                       Form 
                                                                                                                            W-1 REE
▼   PART I: EMPLOYER INFORMATION                     ▼ 
Employer’s Business name                                                                                    Employer’s Federal ID Number 

                                                                                                               Employer’s Account ID 

▼   PART II: APPLICANT INFORMATION                   ▼ 
Last name                                            First name                               MI               Social Security Number 

Address (number and street)                                                          Unit/Apt. no.            Year Refund Requested For 

City, town, or post office                           State                           Zip code                 Employee’s Job Description 

Email                                                Phone no.                       Ext. 

PART III                   1. Number of hours worked outside Louisville Metro, KY during the year 
Work performed             2. Total number of hours worked (excluding holiday, vacation, & sick days) 
outside of                    Normal Work Year = 2080 hours 
Louisville Metro,          3. Percentage of time worked outside Louisville Metro, KY (Divide Line 1 by Line 2) 
KY.                           Must be at least 5% to claim refund – (See instructions) If less than 5% do not 
                              complete this form. 
If all work was            4. Total gross wages per Box 5 or Box 18, whichever is greater on Form W-2 (including 
performed in Louisville       deferred compensation)                                                                                         .00 
Metro, KY, skip to part IV 
                           5. Total wages earned outside Louisville Metro, KY (Multiply Line 3 by Line 4)                                   .00 
Note: If there are stock   6. Local taxable wages (Subtract Line 5 from Line 4)                                                             .00 
options included in your   7. Total Tax Due (Multiply Line 6 by applicable tax rate) 
wages on form                 (1.45% for non-residents, 2.2% for residents, or .75% for resident ministers)                                  .00 
W-2, do not complete 
part III below. Instead,   8. Amount of tax withheld per Form W-2 for prior year or year to date payroll check stub 
complete the section          for current year (Copy of applicable document must be submitted with this 
titled “Stock option          application or delay will occur)                                                                               .00 
worksheet” on Page 2       9. Amount of refund requested (Subtract Line 7 from Line 8)                                                       .00 
PART IV                    ▼  Check all applicable quarters involved in Overpayment   ▼ 
Explanation for               1 stQuarter            2 ndQuarter                          3 rdQuarter                  4 thQuarter 
                              (Jan – Mar)            (Apr – Jun)                          (Jul – Sep)                  (Oct – Dec) 
Refund                     ▼  Check appropriate explanation for overpayment below     ▼ 
                           1.     Occupational taxes withheld from wages while working outside Louisville Metro, KY 
                           2.     School board tax withheld from wages of a non-resident of Louisville Metro, KY during all / part of year 
                           3.     Occupational taxes withheld at a higher rate than 2.2% 
                           4.     Occupational taxes withheld at a higher rate than .75% if a minister 
                           5.     Non-Resident Minister Exempt from .75% tax rate 
                           6.     Other: (Must provide detailed explanation) 

                     ▶     If you are requesting a refund as a result of one of the items described on Line 2-6, please
                           enter the amount of refund you are requesting:                                                                    .00 
                                                                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.metrorevenue.org  Mail Form W-1 REE, along with a copy of Form W-2.  

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

FORM W1-REE                                                                                                                      PAGE 2
PART V                  ▼    This section must be completed if claiming refund as a non-resident of Louisville, Metro KY
Non-Resident            I hereby certify that my residence is
                        Address (number and street)                                                              Unit / Apt. no. 
Statement    

                        City                                            State           Zip Code                 Since 

PART VI                 ▼    This section must be completed if claiming refund at minister’s tax rate
Minister                I hereby certify that I have been ordained since
PART VII                ▼    Employee’s Certification
Signature               I hereby certify that the information provided above is true and correct
                        Signature of Employee                                                                    Date 
Certification 

(Employer’s             ▼    Employer’s Certification
Certification Must be   I hereby certify that the information provided above is true and correct 
notarized) 
                        Employer’s / Agent’s Authorized Signature                                                Date 

                        Print Legal Name of Employer / Agent                                                     Daytime Phone Number 

                        Subscribed and sworn to before me this                          day of                          , 20              by 

                        My Commission Expires: 
                        Notary Signature                                                                         Notary Public, State at Large 

                                                     Stock Option Worksheet 
General                 For any stock option that was included in the gross wages amount on Line 4, Part III, of this 
                        application, enter the year the stock options were granted? 
Information 
Tax Due                 1.   Number of hours worked outside Louisville Metro, KY for the refund year listed in Part II 
Calculation             2.   Total number of hours worked for the refund year listed in Part II 
                             (Excluding holiday, vacation & sick days) Normal work year = 2080 hours 
Excluding Stock         3.   Percentage of time worked outside Louisville Metro, KY (Divide Line 1 by Line 2) 
Options                      Must be at least 5% to claim refund. (If less than 5% enter zero on line 3)                                  % 
Tax Rate (Line 9)       4.   Total gross wages per Box 5 or Box 18, whichever is greater on Form W-2 
Non-residents Rate:          (including deferred compensation and stock options)                                                      .00 
1.45% (.0145), Resident 5.   Value of stock options included on Line 4 above                                                          .00 
Rate: 2.2% (.0220) 
                        6.   Gross wages not including stock option (Subtract Line 5 from Line 4)                                     .00 
                        7.   Total wages earned outside Louisville Metro, KY (Multiply Line 3 by Line 6)                              .00 
                        8.   Local Taxable Wages (Subtract Line 7 from Line 6)                                                        .00 
                        9.   Occupational Tax Due (Multiply Line 8 by applicable tax rate)                                            .00 
Tax Due                 10.  Number of hours worked outside Louisville Metro, KY for the year option was granted 
Calculation on          11.  Total number of hours worked for the year option was granted 
                        12.  Percentage of time worked outside Louisville Metro, KY. (Divide Line 10 by Line 11) 
Stock Options                Must be at least 5% to claim refund. (If less than 5% enter zero on line 12)                                   % 
                        13.  Value of stock options reported in wages per Line 5 above 
Tax Rate (Line 16)                                                                                                                    .00 
Non-residents Rate:     14.  Value of stock options earned outside Louisville Metro, KY 
1.45% (.0145), Resident      (Multiply Line 12 by Line 13)                                                                            .00 
Rate: 2.2% (.0220)      15.  Value of stock options earned inside Louisville Metro, KY 
                             (Subtract Line 14 from Line 13)                                                                          .00 
                        16.  Occupational tax due attributable to stock options (Line 15 multiply by tax rate)                        .00 
Tax Due &               17.  Total Occupational Tax due (Add Line 9 and Line 16)                                                      .00 
Refund                  18.  Amount of tax withheld per Form W-2 or its equivalent (Submit applicable document)                       .00 
Calculation             19.  Amount of Refund Requested                                                                               .00 
Notice: If an employer did not remit the taxes and/or quarterly employee withholding tax return for the period(s) included in this refund 
request, the Louisville Metro Revenue Commission will notify you that no refund will be issued. 

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