Do not use staples. Use only black ink and UPPERCASE letters. 

                                                                                      2016 SD 100 
                                       Rev. 9/16 
                                                               School District Income Tax Return                                                                                                                                                                               
                                                                                                                                                                                                                                                                      16020102
                                                 Note: This form encompasses the SD 100 and amended SD 100X. 

Is this an amended return?                       Yes              No  If yes, include SD RE (do not include a copy of the previously filed return)
Is this a Net Operating Loss (NOL) carryback?                                 Yes       No  If yes, include Schedule IT NOL 
Taxpayer’s SSN (required)                                          If deceased      Spouse’s SSN  (if filing jointly)          If deceased                                                                                                                         Enter school district # for 
                                                                                                                                                                                                                                                                      this return (see instructions). 
                                                                        check box                                                                                                                                                                         check box   SD#
First name                                                                        M.I.  Last name 

Spouse's fi rst name (only if married filing                     jointly)           M.I.  Last name 

Mailing address (for faster processing, use a street address) 

City                                                                                                  State    ZIP code                                                                                                                                   Ohio county (fi rst four letters) 

Home address (if different from mailing address) – do NOT include city or state                                        ZIP code                                                                                                                           Ohio county (fi rst four letters) 

Foreign country (if the mailing address is outside the U.S.)                                               Foreign postal code 

School District Residency –                                  File a separate SD 100 for each taxing school district in which you lived during the taxable year. 
Check applicable box                                                                                Check applicable box for spouse (only if married filing jointly) 
     Full-year                         Part-year resident               Full-year nonresident         Full-year            Part-year resident                                                                                                                           Full-year nonresident
     resident                          of SD# above                     of SD# above                  resident             of SD# above                                                                                                                                 of SD# above 
Enter date                                                                                          Enter date 
of nonresidency                        /         /                to     /            /             of nonresidency          /                                                                                                                         /    to          /    /
Filing Status –                      Check one (must match Ohio income tax return):                 Tax Type –       Check one (for an explanation, see the instructions) 
    Single, head of household or qualifying widow(er)                                               I am fi ling this return because during the taxable year I lived in a(n): 
                                                                                                      Traditional tax base school district.  You must start with Schedule A, 
     Married filing jointly                                                                            line 19 on page 2 of this return. 
                                                                                                      Earned income tax base school district.  You must start with Schedule 
     Married filing separately                                                                         B, line 24 on page 2 of this return. 
1. School district taxable income:               Traditional tax base:Enter on this line the amount you show on line 23. 
                                                                                                                                                                                                                                                                                            00
                                                 Earned income tax base: Enter on this line the amount you show on line 27.... 1.                                                                                                                                   ,      ,               . 
 
2. School district tax rate            .                       times line 1 (rates found in the instructions)...................................... 2.                                                                                                                                      00
                                                                                                                                                                                                                                                                    ,      ,               .
3. Senior citizen credit (you must be 65 or older to claim this credit; limit $50 per return) ............................... 3.                                                                                                                          ,                                 00
                                                                                                                                                                                                                                                                                           .
                                                                                                                                                                                                                                                                                            00
  4. School district income tax liability (line 2 minus line 3; if less than -0-, enter -0-) .......................................... 4.                                                                                                                                 ,               .
5.  worksheetInterest penaltyif you annualizeon underpayment.............................................................................................................................of estimated tax. Include Ohio IT/SD 2210 and the appropriate 5.                                   00
                                                                                                                                                                                                                                                                           ,               . 
                                                                                                                                                                                                                                                                                            00 
6.  Total school district income tax liability before withholding or estimated payments (line 4 plus line 5).... 6.                                                                                                                                                        ,               .

                                       Do not write in this area; for department use only.                                                                                                                                                                          /    / 
                                                                                                                                                                                                                                                            Postmark date                  Code 

                                                                                                                               2016 SD 100 – pg. 1 of 2 

                                                                    2016 SD 100 
                       Rev. 9/16                School District Income Tax Return 
                                                                                                                                                                                       16020202 
   SSN                                             SD# 
                                                                                                                                                                                                            00 
6a. Amount from line 6 on page 1 .................................................................................................................... 6a.                               ,                  . 
  7. School district income tax withheld (school district number on W-2(s), W-2G(s) and/or 1099-R(s) must 
    agree with the school district number on this return). Include W-2(s), W-2G(s) and 1099-R(s) with the                                                                                                   00 
     return ............................................................................................................................................................ 7.             ,                  . 
  8. School district estimated and extension payments made (2016 SD 100ES and/or SD 40P) and credit                                                                                                         00 
    carryforward from previous year return ........................................................................................................ 8.                                  ,                  .
                                                                                                                                                                                                            00 
 9.   Amended return only – amount previously paid with original/amended return .......................................... 9.                                                           ,                  . 
                                                                                                                                                                                                            00 
  10. Total school district income tax payments (add lines 7, 8 and 9) ......................................................... 10.                                                    ,                  .
                                                                                                                                                                                                            00 
11.   Amended return only – overpayment previously requested on original/amended return ........................ 11.                                                                    ,                  .
                                                                                                                                                                                                            00 
12. Line 10 minus line 11. Place a negative sign (“-”) in the box at the right if the amount is less than -0- ..                            ... 12.                                     ,                  . 
            If line 12 is MORE THAN line 6a, go to line 16. OTHERWISE, continue to line 13. 

13. Tax liability (line 6a minus line 12). If line 12 is negative, ignore the negative sign (“-”) and add line 12                                                                                           00 
    to line 6a ..................................................................................................................................................... 13.       ,        ,                  .
                                                                                                                                                                                                            00 
  14. Interest and penalty due on late filing or late payment of tax (see instructions) .................................................. 14.                                  ,        ,                  .
  15. TOTAL AMOUNT DUE (line 13 plus line 14). Include SD 40P (if original return) or SD 40XP (if                                                                                                           00 
    amended return) and make check payable to “School District Income Tax”........ AMOUNT DUE15.                                                                              ,        ,                  .

  16. Overpayment (line 12 minus line 6a) ......................................................................................................... 16.                        ,        ,                  . 00 
 
 17.  Original return only – amount of line 16 to be credited toward 2017 school district income tax liability ............17.                                                 ,        ,                  . 00 
  18. REFUND (line 16 minus line 17) .................................................................................... YOUR  REFUND18.                                     ,        ,                  . 00 
 Schedule A – Traditional Tax Base School District Amounts (see  instructions) 
  Complete this schedule only       if filing a traditional tax base school district return. 
19. Ohio income tax base reported on line 5 of Ohio IT 1040. Place a negative sign (“-“) in the box 
    at the right if the amount is less than -0- ......................................................................................... ... 19.                                                           00 
                                                                                                                                                                               ,        ,                  .
 20. Business income deduction add-back (see instructions) ........................................................................... 20.                                                                  00 
                                                                                                                                                                                        ,                  .
  21. Total traditional tax base school district income (line 19 plus line 20). Place a negative sign (“-“) 
     in the box at the right if the amount is less than -0- ........................................................................      ... 21.                              ,        ,                  .00 
  22. The amount of traditional tax base school district income from line 21, if any, that you earned while 
      not a resident of the school district whose number you entered on this return ......................................... 22.                                              ,        ,                  . 00 
23. School district taxable income (line 21 minus line 22; if less than -0-, enter -0-). Enter here and on 
    line 1 of this return ...................................................................................................................................... 23.                                        00 
                                                                                                                                                                               ,        ,                  . 
 
Schedule B – Earned Income Tax Base School District Amounts (see instructions) 
  Complete this schedule only if fi ling an earned income tax base school district return. 
   24. Wages and other compensation (see instructions) .................................................................................... 24.                                                             00 
                                                                                                                                                                               ,        ,                  .
25. Net earnings from self-employment to the extent included in Ohio adjusted gross income. Place 
    a negative sign (“-“) in the box at the right if the amount is less than -0- ........................................                   ... 25.                                                         00 
                                                                                                                                                                               ,        ,                  .
  26. Depreciation expense adjustment (see instructions) ................................................................................. 26.                                                              00 
                                                                                                                                                                                        ,                  .
  27. School district taxable income (add lines 24, 25 and 26; if less than -0-, enter -0-). Enter here and on 
    line 1 of this return ...................................................................................................................................... 27.                                        00 
                                                                                                                                                                               ,        ,                  .

   Sign Here (required): I have read this return. Under penalties of perjury, I declare that, to                                          If your refund is $1.00 or less, no refund will be issued. 
   the best of my knowledge and belief, the return and all enclosures are true, correct and complete.                                     If you owe $1.00 or less, no payment is necessary. 
                                                                                                                                                                            NO Payment Included  –Mail to: 
 
        Your signature                                                      Date (MM/DD/YY)                                                                                 School District Income Tax 
                                                                                                                                                                               P.O. Box 182197 
                                                                                                                                                                            Columbus, OH 43218-2197 
 Spouse’s signature (see instructions)                                     Phone number 
                                                                                                                                                                            Payment Included  –Mail to: 
                                                                                                                                                                            School District Income Tax 
        Preparer’s printed name (see instructions)          PTIN            Phone number                                                                                       P.O. Box 182389 
        Do you authorize your preparer to contact us regarding this return?         Yes                                   No                                                Columbus, OH 43218-2389 

                                                                                                                                          2016 SD 100 – pg. 2 of 2 

           Electronic Payment Available                                                                                2016 Ohio SD 40P
You can eliminate writing a paper check by using any of 
our electronic payment methods. Go to our Web site at 
tax.ohio.gov for all electronic payment options. 

           Federal Privacy Act Notice 
Because we require you to provide us with a Social Se-
curity number, the        Federal Privacy Act of 1974 requires 
us to inform you that providing us with your Social Secu-
rity number is mandatory. Ohio Revised Code sections 
5703.05, 5703.057 and 5747.08 authorize us to request 
this information. We need your Social Security number in 
order to administer this tax. 

                      Rev. 6/16                                   DO NOT STAPLE OR 
SD 40P                                                            OTHERWISE ATTACH                                     Do NOT fold check or voucher. 
School District Income Tax Payment Voucher                        YOUR PAYMENT TO  
                                                                  DOTHISNOTVOUCHER.SEND CASH. 2016SP                    Use UPPERCASE letters
                                                                                                                        to print the fi rst three letters of 
First name                                M.I.  Last name                                     School district          Taxpayer’s      Spouse’s last name 
                                                                                              number                   last name           (only if joint filing) 
Spouse’s fi rst name (only if joint filing) M.I.  Last name 

Address                                                                                                 Your SSN 

                                                                                              Spouse’s SSN
City, state, ZIP code                                                                                 (if joint filing) 

                                                                                              Amount of 
If you are sending this voucher and paper check or money order (payable to School 
District Income Tax) with or separately from your school district income tax return, mail     Payment         $          ,             ,          0         0
to: School District Income Tax, P.O. Box 182389, Columbus, OH  43218-2389. Write 
the last four digits of the taxpayer’s SSN on the check or money order. 

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