Portsmouth, OH · Scioto County
Application for Refund
Portsmouth residents use this application to request an income tax refund and provide employment details, the refund amount, and an employer certification.
What this form is
This application is for an employee claiming a refund of Portsmouth tax withheld while working outside the city. It must cover only one calendar year and one employer, and asks for employment and address information, the period claimed, the refund amount, and an explanation with dates and locations worked outside Portsmouth. Form W-2 must be attached, and the employer completes a certification.
Who needs it
An employee seeking a refund of Portsmouth tax withheld for work outside the city uses this application and has the employer complete its certification.
How to submit it
Submit the application to the City of Portsmouth, Department of Finance-Income Tax Division, PO Box 1323, Portsmouth, OH 45662-1323.
About notarization
This document is signed without a notary; the applicant signs and dates it, and the employer also signs and dates its certification.
How to submit this form
- 1
Download The Application
Download the Application for Refund PDF.
- 2
Complete The Application
Enter the requested applicant, address, employment, period, and refund information, and explain the dates and locations worked outside Portsmouth.
- 3
Gather The Attachment
Attach Form W-2 to the back of the application.
- 4
Obtain Employer Certification
Have the employer complete and sign the certification section.
- 5
Submit The Application
Submit it to the City of Portsmouth, Department of Finance-Income Tax Division, at the address shown on the form.
Frequently asked questions
- Do I need a notary for the Application for Refund?
- No. The application has no notary block; the applicant signs and dates it, and the employer signs and dates the certification.
- How do I submit the Application for Refund?
- Submit it to the City of Portsmouth, Department of Finance-Income Tax Division, PO Box 1323, Portsmouth, OH 45662-1323.
- What attachment does the application require?
- The form says to attach Form W-2 to the back of the application.
- Can the application cover more than one year or employer?
- No. The form says the application must cover only one calendar year and one employer.