OFFICE  USE 
                                                          APPLICATION 

                                                          FOR   REFUND 
       FOR  TAX                                           City of Akron 
       YEAR 
                                                          INCOME   TAX 

       _________                                          UNDER 18 FILERS                      330-375-2039

Print  Name  &  Address  Below:                                         Telephone Number 

                                                                          Work ____________________________
______________________________________________
______________________________________________                            Home ___________________________ 
______________________________________________
                                                                        SS#_________________________ _____

1. Enter total compensation received before any payroll deductions (attach copies of W-2’s) ………….  $ ___________________
       Print  Employer  Name               Dept Name or #        City Where Employed                    Work Location  (Address) 

       You must submit the following in order for you refund to be processed.

                      1. Legible copy of birth certificate or driver's license.

                      2. Copy of W-2(s) showing Akron wages and Akron tax withheld.

       We will calculate and issue a refund based on the information provided. 
Refunds are typically issued within 90 days after: i) the date the City has received a complete and accurate Refund 
Application, plus a copy of your employer’s complete and accurate AW-3 reconciliation form; or ii) April 15th of the 
year following the tax year at issue, whichever is later.
YOU MUST ATTACH COPIES OF W-2’S SHOWING AKRON WAGES AND AKRON INCOME TAXES WITHHELD. 

       If you were not assigned to the above employer’s Akron payroll for the entire year,  report the date you were assigned 
       to the Akron payroll and/or the date you were transferred out, and/or the date employment was terminated. 

(I worked in Akron from  _________________________  to  _________________________) 

I certify that I have examined this refund application, including any accompanying documents, and to the best of my 
knowledge and belief I attest that these documents represent a true and complete record of my taxable income to Akron. 

_______________________________________________             _______________________________________ 
Signature of Taxpayer                                                                          Date

Return completed form to:   Income Tax Division
                        1 Cascade Plaza -   Suite 100
                        Akron, OH 44308-1161                                                                                      /2022 
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