Bellaire, OH · Belmont County
Income Tax Refund Request Form
Employees use this form to request an income tax refund and have their employer certify earnings and work time in Bellaire.
What this form is
This form documents an employee's refund request for a tax year and includes an employer certification. It asks for the date, tax year, employee name and current address, total earnings, and approximate share of time worked in Bellaire. The employer must complete the certification, and the form says a copy of the employee's W-2 must be attached.
Who needs it
An employee requesting a tax refund uses this form, with the employer completing the certification and attaching a copy of the W-2.
How to submit it
The form lists Village of Bellaire, 3197 Belmont Street, Bellaire, OH 43906, and a fax number of 740-671-6055.
About notarization
This document is signed without a notary; the employer certifies the information and provides a title and date, and the signer just signs and dates it.
How to submit this form
- 1
Download The Form
Download the Income Tax Refund Request Form.
- 2
Complete The Request
Enter the date, tax year, employee name and current address, total earnings, and approximate share of time worked in Bellaire.
- 3
Get Employer Certification
Have the employer complete the certification section and provide a title and date.
- 4
Attach The W-2
Attach a copy of the employee's W-2, as the form requires.
- 5
Submit The Form
The form lists the Village of Bellaire mailing address and fax number.
Frequently asked questions
- Who completes the Income Tax Refund Request Form?
- The employee's refund request includes employee and earnings details. The form states that the employer must complete the certification section.
- What must be attached to the refund request?
- The form says a copy of the employee's W-2 must be attached.
- Do I need a notary for the Income Tax Refund Request Form?
- No. This document is signed without a notary; the employer certifies the information and provides a title and date.
- How do I submit the Income Tax Refund Request Form?
- The form lists Village of Bellaire, 3197 Belmont Street, Bellaire, OH 43906, and fax number 740-671-6055.