Form As-22 - City Of Dayton Refund Request Page 2
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1
2Refund Calculation Worksheet
I
Compute the amount to be entered as taxable city income by multiplying the total compensation by
the ratio of actual days worked. Days worked only refers to actual days on the job.
I
Refunds cannot be claimed for 12 (twelve days) or less days if taxes were not paid to another
municipality for those days.
I
Refund cannot be claimed for virtual office unless it is a requirement of your employment.
Please furnish a letter from your employer on a company letterhead.
EXAMPLE
YOUR CALCULATIONS
1.
261
1.) TOTAL DAYS AVAILABLE
(365 MINUS WEEKENDS NOT WORKED)
a
10
a. VACATION
b
12
b. SICK LEAVE
10
c
c. HOLIDAYS
2.
32
2.) LESS: TOTAL AVAILABLE DAYS NOT WORKED
(ADD a, b & c).
3.
229
3.) SUBTRACT LINE 2 FROM LINE 1
70
4.
4.) LESS: DAYS WORKED OUT OF TOWN
*Remember to attach list of dates and locations.
5.
159
5.) DAYS ON JOB IN THE CITY OF DAYTON
WAGES ON WHICH INCOME TAX IS TO BE PAID
(DIVIDE) (5) DAYS ON THE JOB IN THE CITY
TOTAL INCOME
TAXABLE INCOME
X
=
(3) TOTAL AVAILABLE WORK DAYS
(COLUMN A)
(COLUMN C)
COMPUTATION: (LINE 5) _________________
X
$
=
$
(LINE 3)
Tax Rate for the City of Dayton ........…………….....................2.25%
To have this form
completed in person at
Total Tax Due (To Column D)
(Taxable Income X Tax Rate)
$
our office, you must have
an appointment.
Less: Tax Withheld (To Column E)
Please contact our office
$
for an appointment at
(937) 333-3500.
Refund Due (To Column G)
$
File with: City of Dayton
Income Tax
P.O. Box 1823
Dayton, Ohio 45401-1823
Phone: (937) 333-3500 • Fax: (937) 333-4280 • Forms: (937) 333-3501
website:
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