Mount Vernon, OH · Knox County
Claim for Refund
This form lets eligible employees or employers claim a refund of Mount Vernon income tax withheld or paid in error.
What this form is
Use this claim if you are a nonresident who performed no work within Mount Vernon’s city limits but had city income tax withheld, or an employer seeking a refund of tax paid in error. The claim covers one calendar year and asks for claimant, employment, withholding, address, refund amount, and reason details. Employee claims require a Form W-2 and a schedule of work dates and locations.
Who needs it
A nonresident employee with Mount Vernon tax withheld despite working outside the city, or an employer that paid the city tax in error, may file this claim.
How to submit it
File the original with the Income Tax Division, 3 North Gay Street, Mount Vernon, OH 43050. Employee claims must include Form W-2; attach a schedule of work dates and locations.
About notarization
This form is signed and dated without a notary; a claimant under 18 may attach a notarized parent statement or instead provide a birth certificate or driver’s license.
How to submit this form
- 1
Download The Form
Download the Claim for Refund PDF.
- 2
Complete The Claim
Fill in the claimant, employment, withholding, address, refund amount, and reason details. Cover one calendar year only.
- 3
Gather Required Attachments
For an employee claim, attach Form W-2 and a schedule of work dates and locations. Follow the form’s instructions for claims by people under 18.
- 4
File The Original
File the original with the Income Tax Division, 3 North Gay Street, Mount Vernon, OH 43050.
Frequently asked questions
- Who can use the Claim for Refund?
- The form is for nonresidents who performed no work within Mount Vernon’s city limits but had city income tax withheld, and employers seeking a refund of tax paid in error.
- How do I submit the Claim for Refund?
- File the original with the Income Tax Division at 3 North Gay Street, Mount Vernon, OH 43050. Employee claims must include Form W-2 and a schedule of work dates and locations.
- Do I need a notary for the Claim for Refund?
- No. The form itself is signed and dated without a notary. A claimant under 18 may attach a notarized statement from a parent, or instead provide a birth certificate or driver’s license.