Do I need a notary for the Municipal Income Tax Refund Application?

No. The application has no notary block; the taxpayer signs and dates it. Some claim reasons require an employer representative to complete and sign a certification.

How do I submit the Municipal Income Tax Refund Application?

Mail the completed form and required documentation to the Regional Income Tax Agency at PO Box 470638, Broadview Hts., OH 44147-0638. If filing Form 37, mail the 10A with the completed return.

What documents should I include with my refund claim?

The required documents depend on the reason for your claim. The form lists items such as a W-2, workday log, calculation worksheet, or other supporting records.

Does my employer need to complete part of the application?

Some claim reasons require employer certification on page 2. The form identifies which parts the employer must complete and sign for those reasons.

Waterville, OH · Lucas County

No notary required

Application for Municipal Income Tax Refund

Employees use this application to request a refund of municipal income tax withheld in excess of their liability, with supporting records for the reason claimed.

What this form is

This Regional Income Tax Agency application is used to claim a refund of municipal income tax, including tax withheld for work outside the taxing municipality or tax withheld in excess of the amount due. It asks for taxpayer, employer, income, withholding, and work-location details, and lists documentation and employer certifications needed for different claim reasons.

Who needs it

An employee seeking a municipal income tax refund should complete the application and provide the documents required for the reason for the claim.

How to submit it

Mail the form with the required documentation to the Regional Income Tax Agency, PO Box 470638, Broadview Hts., OH 44147-0638. If filing Form 37, attach the 10A to the completed return and mail them together.

About notarization

This document is signed without a notary; the taxpayer signs and dates the claim, and an employer representative signs when the selected claim reason requires employer certification.

How to submit this form

1
Download The Application
Download the Municipal Income Tax Refund Application PDF.
2
Complete The Claim
Enter your taxpayer, employer, income, withholding, and work-location information, and select the applicable claim reason.
3
Gather Required Documents
Use the claim-reason instructions to gather required records and obtain employer certification where indicated.
4
Mail The Application
Mail the application and required documents to the Regional Income Tax Agency address printed on the form.

Frequently asked questions

Do I need a notary for the Municipal Income Tax Refund Application?: No. The application has no notary block; the taxpayer signs and dates it. Some claim reasons require an employer representative to complete and sign a certification.
How do I submit the Municipal Income Tax Refund Application?: Mail the completed form and required documentation to the Regional Income Tax Agency at PO Box 470638, Broadview Hts., OH 44147-0638. If filing Form 37, mail the 10A with the completed return.
What documents should I include with my refund claim?: The required documents depend on the reason for your claim. The form lists items such as a W-2, workday log, calculation worksheet, or other supporting records.
Does my employer need to complete part of the application?: Some claim reasons require employer certification on page 2. The form identifies which parts the employer must complete and sign for those reasons.

Need something notarized?

This Application for Municipal Income Tax Refund doesn’t need a notary — but if you have another Waterville form that does, a commissioned online notary can help.