Phone No. (270) 842-7168      REFUND REQUEST FORM                                                  Fax No. (270) 842-3411 
                             WARREN COUNTY SCHOOLS OCCUPATIONAL TAX OFFICE 
                              P.O. Box 51530, 303 Lovers Lane, Bowling Green, KY 42103 

E M P L O Y E R  N A M E                             F E D E R A L  I D  #  

E M P L O Y E E  N A M E                             S O C I A L  S E C . #  

M A I L I N G  A D D R E S S                         H O M E  P H O N E #  

C I T Y , S T A T E , Z I P                          W O R K  P H O N E #  

EMAIL ADDRESS 

PERIOD IN WHICH APPLYING FOR REFUND     FROM         TO 

REASON APPLYING FOR REFUND 

IF APPLYING FOR MULTIPLE YEARS COMPLETE SECTION I 

                W2(S) AND PROOF OF RESIDENCY ARE REQUIRED FOR ALL REFUNDS  

SECTION I 

TAX YEAR                       GROSS WAGES $         REFUND AMOUNT $ 

TAX YEAR                       GROSS WAGES $         REFUND AMOUNT $ 

                                                                                                   $ 
                                                     TOTAL REFUND 

COMPLETE SECTION II IF APPLYING FOR A PARTIAL REFUND 

SECTION II                    W-2 AND EVIDENCE OF NON TAXABLE INCOME ARE REQUIRED

      1.        Gross Wages………………………………………………………………………………….. 

      2.        Warren County Occupational Tax Withheld…………………………………………………. 

      3.        Total Number of Days Worked During the Year…………………………………………….. 

      4.        Total Number of Days Worked Outside Warren County, Kentucky…………………………. 

      5.        Percentage Worked Outside Warren County, Kentucky (line 4 divided by line 3)……………… 

      6.        Wages Not Subject to Warren County Occupational Tax (line 1 x line 5)…………………… 

      7.        Refund Due (line 6 x line .005)……………………………………………………………….. 

EMPLOYEE SIGNATURE                                                           DATE 

PRINT NAME ________________________________________________________________  

Phone No. (270) 842-7168        REFUND APPLICATION PROCESS                        Fax No. (270) 842-3411 
                         WARREN COUNTY SCHOOLS OCCUPATIONAL TAX OFFICE  
                         P.O. Box 51530, 303 Lovers Lane, Bowling Green, KY 42103 
                                                                          
According to the Warren County Schools Occupational Tax Ordinance, in effect for 
years beginning on or after January 1, 2008, § 8 – Refunds:  

          A refund may be filed within two (2) years of the due date of the return or the date the 
          money was paid to the tax district, whichever is later. (See Ordinance for further detail or 
          contact our office at 270.842.7168 with any questions regarding the refund timeline) 

If you do not live in the Warren County Public School District but have had Warren County 
Schools Occupational Taxes withheld from your wages, you may receive a refund of that 
withholding.  You will be required to provide certain supporting documents to assist with the 
processing of your request. 

          I.             A W-2 WILL BE REQUIRED FOR EACH YEAR A REFUND IS REQUESTED.

                         Your W-2 must clearly indicate the amount of Warren County Schools
                         Occupational Tax withheld from your earnings. The Warren County Schools
                         Occupational Tax (tax rate of .50%) should be shown separately from the Bowling
                         Green City Occupational Tax (tax rate of 1.85%) and the Warren County
                         Government Occupational Tax (tax rate of 1.00%).

          II.            PROOF OF ADDRESS

                         If you are a property owner, your utility company will be able to provide you with
                         a statement indicating the date utilities were activated in your name and that you
                         are currently residing at that address. If you are not a property owner and cannot
                         obtain such a statement, you should call this office to discuss other forms of proof
                         of residency. A driver’s license is not an acceptable proof of residency.

          III.           MAIL REQUEST TO

                                Warren County Schools Occupational TaxOffice 
                                P.O. Box 51530 
                                Bowling Green, KY 42102-5830