WOODFORD COUNTY
APPLICATION FOR A REFUND OF
WITHHOLDING TAX PAID
FORM RFD-1
APPLICANT’S SOCIAL SECURITY NO._______________________ EMPLOYED BY: _______________________________________________
NAME:___________________________________________________ ADDRESS: ____________________________________________________
ADDRESS:________________________________________________ ____________________________________________________
_________________________________________________ ____________________________________________________
DAYTIME PHONE NO._____________________________________ PHONE:_______________________________________________________
IN ORDER FOR THIS REQUEST TO BE PROCESSED, BOTH THE EMPLOYER AND EMPLOYEE MUST SIGN THE APPLICATION.
FOR OFFICE USE
TOTAL GROSS COMPENSATION, BEFORE ANY PRETAX DEDUCTIONS.
Attach W-2 and any year end earnings summary statements reporting all wages
and local license fee withholding.
Job related expenses (see instructions)
BALANCE (Subtract Line 2 from Line 1)
Wages earned outside of Woodford County. (complete Form RFD-2 )
Adjusted Gross Compensation Subject to License Fee (deduct line 4 from line 3)
License Fee Withheld for Woodford County
License Fee Due (Multiply Line 5 by 1.50%)
AMOUNT TO BE REFUNDED (Subtract Line 7 from Line 6)
I HEREBY CERTIFY THAT THE STATEMENTS MADE HEREIN AND IN ANY SUPPORTING SCHEDULES ARE TRUE, CORRECT, AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
_______________________________________________ __________________________________________
SIGNATURE OF INDIVIDUAL PREPARING RETURN SIGNATURE OF APPLICANT
_______________________________________________ __________________________________________
AUTHORIZED EMPLOYER SIGNATURE CERIFYING THAT INFORMATION IS CORRECT (NAME PRINTED)
______________________________________ _____________________ ___________________________________
TITLE OF EMPLOYER REP PHONE NUMBER DATE
FORM MUST BE SIGNED FOR CONSIDERATION
FORM RFD -1 7/08
Document checksum: 3342032633
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