Phone No. (270) 842-7168                                    REFUND REQUEST FORM                                              Fax No. (270) 842-3411 
  
                        For Years Beginning On or After January 1, 2008 
                        WARREN COUNTY SCHOOLS OCCUPATIONAL TAX OFFICE 
  
                        P.O. Box 51530, 303 Lovers Lane, Bowling Green, KY 42103 
  
 EMPLOYER NAME        FEDERAL ID # 
                                                                                                                              
 EMPLOYEE NAME        SOCIAL SEC. # 
  
 MAILING ADDRESS        HOME PHONE# 
  
 CITY, STATE, ZIP        WORK PHONE# 
  
 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 
                         For Years Beginning On or                   After January 1, 2008 
                         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   
           
                                                     Finance Officer 
                                                     Warren County Schools Occupational Tax Office 
                                                     P.O. Box 51530 
                                                     Bowling Green, KY 42102-5830. 
                         
 Note:  Please be aware that “City of Bowling Green Annexed Areas” are within the 
 Warren County School District.