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GENERAL INSTRUCTIONS
WHO SHOULD USE THIS CLAIM FORM:
1. A Non-Resident who performs no service or work within the corporate limits
of the City of Warren and whose Warren income tax has been withheld by his
employer.
2. Tax withheld on income earned while under sixteen (16) years of age. If you
were under 16 for part of the year, your employer must complete the
Employer Certification. A copy of your birth certificate or driver's license is
required to verify age.
3. A part year resident who moved from the City, is no longer employed in the
City, and whose employer continued to withhold Warren taxes.
4. A Non-Resident whose employer transferred him from Warren to a location
outside the City of Warren, but continued to withhold Warren taxes.
Certification of Employer must be completed by the appropriate individual who has the legal
authority to sign for the company and knows your work schedule.
This claim must be completed in detail and to the best of the taxpayer's knowledge and
belief. The Income Tax Division reserves the right tojre ect any claim if sufficient facts and
details are not included.
Refunds will not be issued during the same year as the tax was erroneously withheld.
There is a three (3) year limitation on all refunds. No refund will be issued for amounts
under $10.00.
A minimum percentage of 40% shall be charged all non-resident employees. A claim for refund could be
granted up to 60% of the tax withheld providing proper documentation is included with the claim.
W-2 FORM(S) FOR THE YEAR(S) BEING CLAIMED MUST BE
ATTACHED. IF THE FORM IS NOT COMPLETED IN ITS
ENTIRETY, CLAIM WILL NOT BE APPROVED AND WILL BE
RETURNED.
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