1 Cascade Plaza - Suite 100 For Tax Year 202  2            PATRICIA CHITTOCK 
Akron, Ohio 44308-1161                                     TAX COMMISSIONER 
Telephone: 330-375-2290                                    Email: incometax@akronohio.gov 
Fax: 330-375-2112                                          www.akronohio.gov/1040 

                            DANIEL HORRIGAN, MAYOR 

                            INCOME TAX DIVISION 
                                 DEPARTMENT OF FINANCE 

Dear Taxpayer,

Use the Non-Resident Employee Refund Application if your request is for 
days worked outside of Akron.  You must complete the entire form. Then have 
the days worked in Akron verified for accuracy by your employer. (The 
appropriate individual is one who has legal authority to sign for the company 
and knows your work schedule.)   

In addition, please be advised that we will be notifying your resident city. It 
appears that one of the intentions of the new State law is to hold the employee 
responsible to pay either the city where the work was performed or the base 
city of employment, when both are taxing municipalities. Since you are 
receiving a refund of taxes withheld for your base city of employment, the city 
of residence may elect to pursue recovery of these dollars.

Refunds are issued within 90 days after the City has receipt of the correctly 
completed Refund Application and itinerary forms, or after receipt of the 
employer’s correct AW-3 reconciliation form, including all W-2 information, 
whichever is later. 

Sincerely, 
Income Tax Division 
Refund Section 
330-375-2039

Revised: 1/2023

                                                   For Tax Year 202 2

       NON-RESIDENT EMPLOYEE REFUND APPLICATION 
                                                  For Days Worked Out of Akron   
                                                  Or Taxes Over Withheld by Employer 

☐During the year 202 ,2  my employment with __________________________________________ located in the City of
Akron, required me to perform services both inside and outside the corporate boundaries of the City as follows:

    Total Days Paid 52 Weeks @ 5 Days per Week or 260 Working Days: 
                         (or dates of employment -beginning ________________ thru ________________ ) 
                                 Number of Working Days Outside Akron ____________ To be Refunded 
                                   Number of Working Days In Akron ____________ 
                                                       (Attach itinerary)

                                                            OR
☐During the year 2022, my employer ______________________________________ over withheld Akron city income
taxes for the following reason:

 Work from home                  Withheld in error Over withheld OTR driver           Other _________________________

Under penalties of perjury I hereby certify that the information provided herein is true, correct and complete to the best 
of my knowledge and belief.  

Print Employee’s Name                                              Date  

Employee’s Signature                                               Social Security Number 

Employee’s Street Address                                         Daytime Phone Number 

Employee’s City, State, Zip                                         City of Residence 

      You must attach copies of W-2’s showing Akron wages and Akron income taxes withheld. 

    We will calculate and issue a refund (if any) based on the information provided. 

Payment will be made within 90 days of receipt of the completed refund request and receipt of a completed employer 
annual withholding return OR within 90 days of April 15th of the year following the tax year at issue, whichever is later. 

 ~ ~ ~ ~ ~ ~ ~ ~ ~ EMPLOYER’ S VERIFICATION ~ ~ ~ ~ ~ ~ ~ ~ ~ 
The number of days work in Akron shown above reflect actual working days at principal place of work. Additionally, no 
refund of withheld taxes have been paid to employee. 

Employer’s / Manager’s Signature                                   Date 

Print Employer’s / Manager’s Name                                  Title 

Employer’s / Manager’s Phone Number and Extension 

                                   Please mail completed form and copy of W-2 to:

                               Income Tax Division -1 Cascade Plaza – Suite 100 -Akron, OH 44308 
                                   Forms are available at akronohio.gov/1040 or by calling 330-375-2039. 

Date ___________________________ 

Days Days Days Days Days Days Days Days Days Days Days Days Days Days Days Days 

ITINERARY FOR DAYS WORKED OUT OF AKRON 

Purpose of Trip 

LOCATION CITY, STATE

To 

Date
From 
Name ______________________________________________________ PAGE TOTAL Do Not Include Vacation, Sick, Holiday, Weekends or Other Paid Non-Working Days.