Henderson, KY · Henderson County
Employee Request for Refund of Payroll Tax Withheld
This form lets a City of Henderson employee request a refund of occupational payroll tax withheld on wages, with employer verification and supporting documentation.
- licensed online notary
- ~15 min average
- Notarized PDF emailed
What you’ll need
- Government-issued photo ID
- Webcam-enabled device (laptop or phone)
- This form, ready to upload as a PDF
What this form is
Employees use this form to request a refund for occupational taxes withheld on wages, including wages earned while working outside Henderson. The application asks for work-hour and wage calculations, an explanation of the overpayment, and supporting documents; it also requires employer verification. The form states that requests must be made within two years of the overpayment and that applicants seeking a refund for taxes paid elsewhere must provide proof of payment or proof that no tax is due.
Who needs it
A Henderson employee seeking a refund of occupational tax withheld from wages must complete the application and obtain verification from their employer.
Why it needs a notary
The employee certification and employer verification each include a State of Kentucky and county jurat; both signers must swear to their statements before a notary.
How to get this notarized
- 1
Download the Refund Form
Get the City of Henderson Employee Request for Refund of Payroll Tax Withheld form.
- 2
Complete the Application
Enter employee and employer details, refund year, reason, work-hour calculations, and supporting information.
- 3
Book an Online Notary
Arrange an online notarization for the employee certification and employer verification.
- 4
Sign on Video
Both signers appear before the notary and swear to their statements.
- 5
Submit to the City
Attach required supporting documents and submit the completed application to the City of Henderson.
Preview the form
The blank PDF straight from Henderson. Look it over, then upload your filled copy to start the notary session.
You’ll need ID and a webcam.
A licensed online notary will join you on video, verify your government-issued ID, witness your signature, and apply their seal. You’ll receive the notarized PDF by email when the session ends.
Frequently asked questions
- How do I request a Henderson payroll tax refund?
- Complete the employee information and refund calculations, explain the overpayment, attach required supporting documents, and obtain employer verification. The form states requests must be made within two years of the overpayment.
- Do I need to notarize both statements?
- Yes. The form has a separate subscribed-and-sworn jurat for the employee certification and the employer verification, so each signer must appear before a notary.
- Can I sign this form with an online notary?
- Kentucky authorizes its notaries to perform online notarizations through online notary public registration under KRS 423.355. Use a commissioned online notary and check with the city about accepting the completed form.
- What documents may I need to include?
- The form requests a W-2 and says applicants seeking a refund for taxes paid in another jurisdiction must provide proof of payment there or proof that no tax is due. Confirm with the city or county clerk if unsure.