Shively, KY · Jefferson County
Employee Occupational Tax Refund Application
This application requests a refund of Shively occupational taxes withheld from an employee’s wages and is filed by the employee with employer verification.
- 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 application to request a refund for a specified year and quarter when Shively occupational taxes were overwithheld or the employee worked outside Shively. The employee provides wage, withholding, and work-time information, and the employer verifies the information with a signature. Submit a separate application for each employee with a W-2 or year-to-date pay stub; the form states requests must be postmarked within one year of the annual reconciliation and W-2 due date.
Who needs it
An employee seeking a Shively occupational tax refund must complete the application, provide wage documentation, and obtain the employer’s verification and signature.
Why it needs a notary
The form includes a sworn-and-subscribed jurat; the authorized corporate representative certifying the information must sign before the notary.
How to get this notarized
- 1
Download The Application
Get the City of Shively Employee Occupational Tax Refund Application.
- 2
Complete The Application
Fill in the employee, employer, refund, and certification information. Include the applicable quarters and wage documentation.
- 3
Book An Online Notary
Arrange an online notarization for the certification signature by the authorized corporate representative.
- 4
Sign On Video
Sign the certification during the online notary appointment and complete the sworn jurat.
- 5
Submit To The City
Send the signed application and required W-2 or year-to-date pay stub to the City of Shively.
Preview the form
The blank PDF straight from Shively. 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 Shively occupational tax refund?
- Complete a separate application for each employee, attach a W-2 or year-to-date pay stub, obtain employee and employer signatures, and submit it to the City of Shively.
- Do I need to have a signature notarized?
- Yes. The form says the certification signature must be notarized. It also requires signatures from the employee and employer, with the employer verifying the information.
- Can I sign the certification with an online notary?
- Kentucky authorizes online notarization by a commissioned online notary registered for online acts. Book a session, then sign the certification during the video appointment.
- When must I submit the refund application?
- The form states that the request must be postmarked within one year from the date the annual reconciliation and W-2 data are due. Contact the City of Shively with questions; confirm with the city or county clerk if unsure.