Commissioned (not hourly or salaried) employees can use this form to apply for a refund on Wage Tax. You can also use our online refund forms, for faster and more secure processing.

Any claim for refund must be filed within three years from the date the tax was paid or due, whichever date is later. Only non-resident employees are eligible for a refund based on work performed outside of Philadelphia.

Please return this form using the postal service to the address printed on them. Because this form contains confidential information, please do not submit it by email. Email is not a secure way of sending confidential information.

We may contact you if we need more information.