Tax Refund Request For Individuals Under Age 18 - City Of Dublin

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City of D ublin
Division of Taxation
P.O. Box 9062
Dublin, Ohio 43017-0962
Telephone (614) 410-4460
Toll Free (888) 490-8154
Fax
(614) 923-5542
TAX REFUND REQUEST FOR INDIVIDUALS UNDER AGE 18
TAX YEAR: ________
Please Print
NAME: _________________________________ SOCIAL SECURITY: _____________________
PRESENT ADDRESS: ___________________________________________________________
CITY, STATE AND ZIP CODE: ____________________________________________________
TELEPHONE NO. ________________________________
TOTAL DUBLIN TAX WITHHELD $ ________________
REFUND AMOUNT REQUESTED $__________________
COMPANY NAME: _____________________________________________________________
ADDRESS WHERE WORKED: __________________________________________________
PROOF OF BIRTH MUST ACCOMPANY THIS REQUEST FOR A REFUND. PROOF
SHOULD BE A LEGIBLE COPY OF BIRTH CERTIFICATE OR DRIVER’S LICENSE.
W-2 FORM MUST BE ATTACHED.
SIGNATURE: ____________________________________ DATE: ______________________
NOTICE:
PLEASE ALLOW 90 DAYS FOR PROCESSING OF YOUR REFUND REQUEST

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