2015 SD 141 Long Rev. 11/14
School District Income Tax School District Employer’s Annual
P.O. Box 182388 15090100
Columbus, OH 43218-2388 Reconciliation of Tax Withheld
Ohio withholding acct. no. FEIN Payment due date Go paperless! File your
02/01/2016 return through Ohio
Business Gateway:
Name tax.ohio.gov
Amended Return
Number and street Check box if amended return.
City, state, ZIP code Final Return
Check box if out of business
or no more SD employees.
If you do not owe any taxes, write -0- in the space on line 3. If you have a bal- 1. Enter the total amount of
ance due, mail one check payable to School District Income Tax for the total school district income tax re-
amount. Complete the tax liability and the total payment for each school district quired to be withheld for ALL
for which you withheld tax. active school districts during $
2015. , ,
If this return is an amended SD 141 (i) you must include on the lines below any
underpayment/overpayment(s) that were on any previously fi led SD 141(s) and 2. Enter the amount of pay-
then add any further adjustments; (ii) add to line 2 total payments made on any ments made for 2015 on
previously fi led SD 141(s); and (iii) deduct from line 2 total refund(s) received on Ohio form SD 101 for ALL $
any previously fi led SD 141(s). active school districts. , ,
DO NOT STAPLE OR OTHERWISE ATTACH YOUR CHECK OR CHECK STUB 3. If line 2 is LESS than line 1,
TO THIS FORM. DO NOT SEND CASH. Make check payable to SCHOOL DIS- subtract line 2 from line 1 and
TRICT INCOME TAXand mail to School District Income Tax, P.O. Box 182388, enter the balance of school
Columbus, OH 43218-2388. district income tax due.
AMOUNT YOU OWE $ , ,
I declare under penalties of perjury that this return, including any accompanying
schedules and statements, has been examined by me and, to the best of my 4. If line 2 is GREATER than
knowledge and belief, is a true, correct and complete return and report. line 1, subract line 1 from line
2 and enter the overpayment
Signature Title Date YOUR REFUND , ,
of school district income tax. $
If your refund is $1.00 or less, no refund will be issued.
If you owe $1.00 or less, no payment is necessary.
A B C D E
School District Name School School District Income Amount Underpayment/
District No. Tax Withheld of Payment (Overpayment)