Do I need a notary for the Non-Resident Income Tax Refund Request Form?

No. The claimant signs and dates the form under a perjury certification. The employer must complete its certification section or provide the same information on company letterhead.

What documents must accompany the refund request?

Attach a W-2 showing Marysville withholdings. The employer must complete the certification or provide the same information on company letterhead; attach a work-site log if there was more than one work site.

Do I need a separate form for each employer or year?

Yes. The form says a separate request form is needed for each employer and/or tax year.

Marysville, OH · Union County

No notary required

Non-Resident Income Tax Refund Request Form

Non-residents use this form to request a refund of Marysville income tax withheld from their wages and provide information about their employment.

What this form is

This form lets a non-resident request a refund of Marysville income tax withheld from wages. The applicant provides personal, employer, work-location, employment-date, and refund-reason information; a W-2 showing Marysville withholdings must be attached. The employer must complete the certification section or provide the same information on company letterhead, and a work-site log is required if there was more than one work site.

Who needs it

A non-resident seeking a refund of Marysville income tax withheld by an employer should complete this form for each employer and tax year.

How to submit it

Send the completed form and required documents to PO Box 385, Marysville, OH 43040-0385. The form also lists [email protected] and fax number (937) 645-7353.

About notarization

No notary is required; the claimant signs and dates under a perjury certification, and the employer must certify the information or provide it on company letterhead.

How to submit this form

1
Download the Form
Download the Non-Resident Income Tax Refund Request Form.
2
Complete the Applicant Section
Enter your information, tax year, employer, work location, employment dates, and reason for the refund; sign and date the form.
3
Gather Required Documents
Attach a W-2 showing Marysville withholdings and obtain the employer certification or equivalent company-letterhead information. Attach a work-site log if needed.
4
Send the Request
Send the completed form and documents to PO Box 385, Marysville, OH 43040-0385.

Frequently asked questions

Do I need a notary for the Non-Resident Income Tax Refund Request Form?: No. The claimant signs and dates the form under a perjury certification. The employer must complete its certification section or provide the same information on company letterhead.
How do I submit the Non-Resident Income Tax Refund Request Form?: Send the completed form and required documents to PO Box 385, Marysville, OH 43040-0385. The form also lists an email address and fax number.
What documents must accompany the refund request?: Attach a W-2 showing Marysville withholdings. The employer must complete the certification or provide the same information on company letterhead; attach a work-site log if there was more than one work site.
Do I need a separate form for each employer or year?: Yes. The form says a separate request form is needed for each employer and/or tax year.

Need something notarized?

This Non-Resident Income Tax Refund Request Form doesn’t need a notary — but if you have another Marysville form that does, a commissioned online notary can help.