Do I need a notary for the 2021 COVID-19 Nonresident Refund Request?

No. The employee signs and dates the certification, and the employer representative signs and dates the verification; neither section requires a notary.

How do I submit the refund request?

Mail the completed form and a copy of your W-2 to Income Tax Dept, 202 W Maple, Hartville, OH 44632.

What attachments does the form require?

Attach a copy of your federal Form W-2(s). If you worked a hybrid schedule, also attach a log of days worked outside Hartville.

What information does the form ask for?

It requests employee and employer details, gross pay and workday calculations, days worked outside Hartville, and employer verification.

Hartville, OH · Stark County

No notary required

2021 COVID-19 Nonresident Refund Request

Hartville nonresidents use this form to request an income tax refund for days they worked outside the village because of the Coronavirus pandemic.

What this form is

This form requests a refund for income tax related to days an employee worked outside Hartville because of the Coronavirus pandemic and the governor's declaration of a state of emergency. It asks for employee and employer details, pay and workday calculations, and employer verification. Attach federal Form W-2(s); include a log of days worked outside Hartville if working a hybrid schedule.

Who needs it

A nonresident employee seeking a refund for days worked outside Hartville because of the Coronavirus pandemic should complete this request.

How to submit it

Mail the completed form and a copy of the W-2 to Income Tax Dept, 202 W Maple, Hartville, OH 44632. For assistance, call 330-877-9222 or email [email protected].

About notarization

No notary is required; the employee signs and dates the certification, and the employer representative also signs and dates the verification.

How to submit this form

1
Download The Form
Download the 2021 COVID-19 Nonresident Refund Request.
2
Complete The Form
Enter employee and employer details and complete the pay and workday calculations.
3
Gather Attachments
Attach federal Form W-2(s) and, if working a hybrid schedule, a log of days worked outside Hartville.
4
Sign And Mail
Sign and date the employee certification, obtain the employer verification, and mail the form and W-2 copy to the Income Tax Dept at 202 W Maple, Hartville, OH 44632.

Frequently asked questions

Do I need a notary for the 2021 COVID-19 Nonresident Refund Request?: No. The employee signs and dates the certification, and the employer representative signs and dates the verification; neither section requires a notary.
How do I submit the refund request?: Mail the completed form and a copy of your W-2 to Income Tax Dept, 202 W Maple, Hartville, OH 44632.
What attachments does the form require?: Attach a copy of your federal Form W-2(s). If you worked a hybrid schedule, also attach a log of days worked outside Hartville.
What information does the form ask for?: It requests employee and employer details, gross pay and workday calculations, days worked outside Hartville, and employer verification.

Need something notarized?

This 2021 COVID-19 Nonresident Refund Request doesn’t need a notary — but if you have another Hartville form that does, a commissioned online notary can help.