Rev. 11/4/16

Scan Specifi cations for the 

2016 SD 100

Important Note

The following document (2016 SD 100) contains grids for placement of 
information on this specifi c tax form. To accurately print, do not reduce 
the size, rotate or center this document. Doing so will jeopardize the 
integrity of the grid. When printing from Adobe Reader, please select 
“None” for “Page Scaling,” which is under “Page Handling.”

       Ohio Department of Taxation

                        4485 Northland Ridge Blvd.

                        Columbus, OH 43229

                        tax.ohio.gov

Grid layout 

with notations

123456789 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85
2
3
4                                                               Do not use staples. Use only black ink and UPPERCASE letters. 
5                          New! The date the return was gen-
                                                                                                    2016 SD 100 
6                          erated by the taxpayer (MM DD YY).
7                          Rev. 9/16                            School District Income Tax Return
                                                                                                                                                                                                             16020110
8
9      88 88 88                            Note: This form encompasses the SD 100 and amended SD 100X.

10 Is this an amended return?                                    X Yes         XNoIf yes, include SD RE (do not include aPlacementcopy of theofpreviouslythe 1D barcodefi led return)and tax year is critical. 
11 Is this a Net Operating Loss (NOL) carryback?                           X         Yes          X No                                 If yes, includeMakeSchedulesure to followIT NOLthe grid positions for layout. Do 
12                                                                                                                                             not forget to get your barcode(s) assignments for 
13 Taxpayer’s SSN (required)                                            If deceased               Spouse’s SSN(if fi ling jointly)every form, version and page.If deceased                                Enter school district # for 
14                                                                                                                                                                                                           this return (see instructions).
   888 88  8888                                                              X                      888 88  8888                                                                               X
15                                                                        check box                                                                                                            check box     SD#                  8888
16 First name                                                                              M.I.        Last name
17 JOHNXXXXXXXXXXX                                                                         Q                 PUBL I CXXXXXXXXXXXXXX        
18
19 Spouse's fi rst name (only if married fi ling jointly)                                    M.I.        Last name
20 JANEXXXXXXXXXXX                                                                         Q                 PUBL I CXXXXXXXXXXXXXX        
21
22 Mailing address (for faster processing, use a street address)
23 8888  CHERRY    LANEXXXXXXXXXXXXXXXXXXX
24
25 City                                                                                                                                        State      ZIP code                             Ohio county (fi rst four letters)
26 CITYXXXXXXXXXXXXXXXX                                                                                                                        OH         88888                                PICK
27
28 Home address (if different from mailing address) – do NOT include city or state                                                                        ZIP code                             Ohio county (fi rst four letters)
29 8888  BERRY AVEXXXXXXXXXX                                                                                                                              88888                                FRAN
30
   Foreign country (if the mailing address is outside the U.S.)                                                                                           Foreign postal code
31
32 JAPANXXXXXXXXXXXXXXX                                                                                                                                   8888888
33
34 School District Residency – File a separate SD 100 for each taxing school district in which you lived during the taxable year.
35 Check applicable box                                                                                                                    Check applicable box for spouse (only if married fi ling jointly)
36      Full-year          Part-year resident                                Full-year nonresident                                             Full-year                           Part-year resident                    Full-year nonresident 
37 X                   X                                             X                                                                    XXX                                      of SD# above
        resident           of SD# above                                      of SD# above                                                      resident                                                                  of SD# above
   Enter date                                                                                                                              Enter date 
38 of nonresidency         88 88 88                             to        88 88 88                                                         of nonresidency                         88 88 88              to              88 88 88
39
40 Filing Status – Check one (must match Ohio income tax return):                                                                          Tax Type – Check one (for an explanation, see the instructions)
41 X   Single, head of household or qualifying widow(er)                                                                                   I am fi ling this return because during the taxable year I lived in a(n):
                                                                                                                                                                                               New! Do not place spaces be-
42                                                                                                                                        X    Traditional tax base school district.tween whole dollar numbers. There  You must start with Schedule A, 
43     Married fi ling jointly                                                                                                                  line 19 on page 2 of this return.
   X                                                                                                                                                                                           is only a space between dollar 
44                                                                                                                                        X    Earned income tax base school district.amounts and cents fi elds. You must start with Schedule 
45     Married fi ling separately                                                                                                               B, line 24 on page 2 of this return.
   X
46
47
48 1. School district taxable income:      Traditional tax base:Enter on this line the amount you show on line 23.
                                           Earned income tax base:                         EnterFor staticon thistextlineusetheArialamountfont (blackyouink)showand tryontoline 27 .... 1.                  888888888  00
49 2.  School district tax rate            .8888                times line 1 (ratesmatchfoundsize.in theForinstructions)data entry fi elds......................................(shown in red 2.             88888888  00
                                                                                           for identifi cation purposes only), use Arial font 
   3.  Senior citizen credit (you must be 65 or older to claim this credit; limit $50 per return) ............................... 3.
50                                                                                         (black ink). All the data entry fi elds must follow                                                                                       88 00
51 4.  School district income tax liability (line 2 minus line 3; if lessgridthanlayout.-0-, enterWhen-0-) ..........................................a  fi eld  refl ects a negative 4.                                     888888  00
52                                                                                         amount, make sure there is no space between 
53 5.  Interest penalty on underpayment of estimated tax. Include Ohio IT/SD 2210 and the appropriate the amount and the negative sign. Never hard 
     worksheet if you annualize .............................................................................................................................code a negative sign.        5.                              888888  00
54 6. Total2Dschoolbarcodedistrictrequired.incomeDelete thistax liability before withholding or estimated payments (line 4 plus line 5).... 6.                                                                            888888  00
55         box with text and replace it with 
56         the 2D barcode.                                                                                                                                                                     Target marks or registration marks 
57                                                                                                                                                                                             must measure 6 mm X 6 mm. The 
58                                                                                                                                                                                             four target marks or registration 
59                     Do not write in this area; for department use only.                                                                                                                     marks on every page must follow 
                                                                                                                                                                                               grid/ layout./
60
61                                                                                                                                                                                             Postmark date                        Code
62
63                                                                                                                                                             2016 SD 100 – page 1 of 2
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123456789 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85
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4                                                                                                     
5
                                                                                   2016 SD 100 
6
7                              Rev. 9/16         School District Income Tax Return
8                                                                                                                                                                                     16020210
9       SSN       888 88  8888                            SD#       8888
10
11
   6a. Amount from line 6 on page 1 ...........................................................................................................................  6a.                                                888888 00    
12
     7. School district income tax withheld (school district number on W-2(s), W-2G(s) and/or 1099-R(s) must 
13       agree with the school district number on this return). Include W-2(s), W-2G(s) and 1099-R(s) with the return ........ 7.                                                                                   888888 00    
14
     8. School district estimated and extension payments made (2016 SD 100ES and/or SD 40P) and credit 
15     carryforward from previous year return .............................................................................................................  8.                                                     888888 00    
16  9.   Amended return only          – amount previously paid with original/amended return ............................................... 9.                                                                      888888 00    
17
18  10.  Total school district income tax payments (add lines 7, 8 and 9) ................................................................ 10.                                                                      888888 00    
19
20 11.   Amended return only          – overpayment previously requested on original/amended return ............................... 11.                                                                             888888 00    
21
22 12. Line 10 minus line 11 ........................................................................................................................................ 12.                                           888888 00    
23
24                   If line 12 is MORE THAN line 6a, go to line 16. OTHERWISE, continue to line 13.
25  13. Tax liability (line 6a minus line 12) ................................................................................................................................. 13.                       8888888 00             
26                                                                                                                                                                                                        8888888 00             
    14. Interest and penalty due on late fi ling or late payment of tax (see instructions) ....................................................... 14.
27
    15.  TOTAL AMOUNT DUE (line 13 plus line 14). Include SD 40P (if original return) or SD 40XP (if 
28     amended return) and make check payable to “School District Income Tax” ............ AMOUNT DUE                                                                      15.                88888888 00                       
29   
30  16. Overpayment (line 12 minus line 6a) .............................................................................................................  16.                                            8888888 00             
31  
32  17.  Original return only– amount of line 16 to be credited toward 2017 school district income tax liability ................   17.                                                                   8888888 00             
33
34  18.  REFUND (line 16 minus line 17) ..........................................................................................YOUR REFUND                              18.                           8888888 00             
35 Schedule       A – Traditional Tax Base School District Amounts (see instructions)
36   Complete this schedule only if fi ling a traditional tax base school district return.
37                                                                                                                                                                                 888888888 00                                  
   19. Ohio income tax base reported on line 5 of Ohio IT 1040 ..............................................................................  19.
38                                                                                                                                                                                                                  888888 00    
   20. Business income deduction add-back (see instructions) ...............................................................................  20.
39                                                                                                                                                                                 888888888 00                                  
    21. Total traditional tax base school district income (line 19 plus line 20) ............................................................  21.
40  
41  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.                                         888888888 00                                  
42
43                                                                                                                                                                                 888888888 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.
44  
   Schedule B – Earned Income Tax Base School District Amounts (see instructions)
45 Complete       this schedule only if fi ling an earned income tax base school district return.
46
   24. Wages and other compensation (see instructions) ........................................................................................  24.                               888888888 00                                  
47
48  
   25. Net earnings from self-employment to the extent included in Ohio adjusted gross income ...........................  25.                                                     888888888 00                                  
49                                                                                                                                                                                                                  888888 00    
    26. Depreciation expense adjustment (see instructions) .....................................................................................  26.
50
51  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.                                   888888888 00                                  
52
53      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.
54
55                                                                                                                                                                         NO Payment Included   Mail–                       to:
    Your signature                                                                            Date (MM/DD/YYYY)                                                                School District Income Tax
56                                                                                                                                                                                 P.O. Box 182197
57                                                                                                                                                                         Columbus, OH 43218-2197
    Spouse’s signature (see instructions)                                                     Phone number
58
                                                                                                                                                                           Payment Included   Mail–                          to:
59                                                                                                                                                                              School District Income Tax
               Preparer’s printed name (see instructions)      PTIN                            Phone number
60                                                                                                                                                                                 P.O. Box 182389
                                                                                                                                                                           Columbus, OH 43218-2389
61             Do you authorize your preparer to contact us regarding this return?                   XXYes                        No
62
63
                                                                                                                                       2016 SD 100 – page 2 of 2
64
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Grid layout

123456789 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85
2
3
4                                                   Do not use staples. Use only black ink and UPPERCASE letters. 
5
                                                                                                 2016 SD 100 
6
7                        Rev. 9/16           School District Income Tax Return
                                                                                                                                                                                16020110
8
9      88 88 88                       Note: This form encompasses the SD 100 and amended SD 100X.

10 Is this an amended return?                                    X Yes         XNoIf yes, include SD RE (do not include a copy of the previously fi led return)
11 Is this a Net Operating Loss (NOL) carryback?                           X         Yes          X No                        If yes, include Schedule IT NOL
12
13 Taxpayer’s SSN (required)                         If deceased                               Spouse’s SSN (if fi ling jointly)                             If deceased     Enter school district # for 
14                                                                                                                                                                              this return (see instructions).
   888 88  8888                                           X                                      888 88  8888                                                          X
15                                                        check box                                                                                              check box      SD#                   8888
16 First name                                                                              M.I.     Last name
17 JOHNXXXXXXXXXXX                                                                         Q        PUBL I CXXXXXXXXXXXXXX        
18
19 Spouse's fi rst name (only if married fi ling jointly)                                    M.I.     Last name
20 JANEXXXXXXXXXXX                                                                         Q        PUBL I CXXXXXXXXXXXXXX        
21
22 Mailing address (for faster processing, use a street address)
23 8888  CHERRY    LANEXXXXXXXXXXXXXXXXXXX
24
25 City                                                                                                                               State    ZIP code                Ohio county (fi rst four letters)
26 CITYXXXXXXXXXXXXXXXX                                                                                                               OH        88888                  PICK
27
28 Home address (if different from mailing address) – do NOT include city or state                                                              ZIP code               Ohio county (fi rst four letters)
29 8888  BERRY AVEXXXXXXXXXX                                                                                                                    88888                  FRAN
30
   Foreign country (if the mailing address is outside the U.S.)                                                                                Foreign postal code
31
32 JAPANXXXXXXXXXXXXXXX                                                                                                                         8888888
33
34 School District Residency – File a separate SD 100 for each taxing school district in which you lived during the taxable year.
35 Check applicable box                                                                                                           Check applicable box for spouse (only if married fi ling jointly)
36      Full-year        Part-year resident               Full-year nonresident                                                       Full-year           Part-year resident                 Full-year nonresident 
37 X                   X                            X                                                                            XXX                      of SD# above
        resident         of SD# above                     of SD# above                                                                resident                                               of SD# above
   Enter date                                                                                                                     Enter date 
38 of nonresidency       88 88 88                   to    88 88 88                                                                of nonresidency         88 88 88           to              88 88 88
39
40 Filing Status – Check one (must match Ohio income tax return):                                                                 Tax Type – Check one (for an explanation, see the instructions)
41 X   Single, head of household or qualifying widow(er)                                                                          I am fi ling this return because during the taxable year I lived in a(n):
42                                                                                                                               X    Traditional tax base school district. You must start with Schedule A, 
43     Married fi ling jointly                                                                                                         line 19 on page 2 of this return.
   X
44                                                                                                                               X    Earned income tax base school district. You must start with Schedule 
45     Married fi ling separately                                                                                                      B, line 24 on page 2 of this return.
   X
46
47
48 1. School district taxable income: Traditional tax base:Enter on this line the amount you show on line 23.
                                      Earned income tax base:                              Enter on this line the amount you show on line 27 .... 1.                            888888888  00
49 2.  School district tax rate    .8888            times line 1 (rates found in the instructions) ...................................... 2.                                    88888888  00
50                                                                                                                                                                                                      88 00
   3.  Senior citizen credit (you must be 65 or older to claim this credit; limit $50 per return) ............................... 3.
51 4.  School district income tax liability (line 2 minus line 3; if less than -0-, enter -0-) .......................................... 4.                                                  888888  00
52
53 5.  Interest penalty on underpayment of estimated tax. Include Ohio IT/SD 2210 and the appropriate 
     worksheet if you annualize ............................................................................................................................. 5.                              888888  00
54 6.  Total school district income tax liability before withholding or estimated payments (line 4 plus line 5).... 6.                                                                        888888  00
55
56
57
58
59                     Do not write in this area; for department use only.
                                                                                                                                                                       /        /
60
61                                                                                                                                                                    Postmark date                     Code
62
63                                                                                                                                                2016 SD 100 – page 1 of 2
64
65
66

123456789 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85
2
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4                                                                                                     
5
                                                                                   2016 SD 100 
6
7                              Rev. 9/16         School District Income Tax Return
8                                                                                                                                                                                     16020210
9       SSN       888 88  8888                            SD#       8888
10
11
   6a. Amount from line 6 on page 1 ...........................................................................................................................  6a.                                                888888 00    
12
     7. School district income tax withheld (school district number on W-2(s), W-2G(s) and/or 1099-R(s) must 
13       agree with the school district number on this return). Include W-2(s), W-2G(s) and 1099-R(s) with the return ........ 7.                                                                                   888888 00    
14
     8. School district estimated and extension payments made (2016 SD 100ES and/or SD 40P) and credit 
15     carryforward from previous year return .............................................................................................................  8.                                                     888888 00    
16  9.   Amended return only          – amount previously paid with original/amended return ............................................... 9.                                                                      888888 00    
17
18  10.  Total school district income tax payments (add lines 7, 8 and 9) ................................................................ 10.                                                                      888888 00    
19
20 11.   Amended return only          – overpayment previously requested on original/amended return ............................... 11.                                                                             888888 00    
21
22 12. Line 10 minus line 11 ........................................................................................................................................ 12.                                           888888 00    
23
24                   If line 12 is MORE THAN line 6a, go to line 16. OTHERWISE, continue to line 13.
25  13. Tax liability (line 6a minus line 12) ................................................................................................................................. 13.                       8888888 00             
26                                                                                                                                                                                                        8888888 00             
    14. Interest and penalty due on late fi ling or late payment of tax (see instructions) ....................................................... 14.
27
    15.  TOTAL AMOUNT DUE (line 13 plus line 14). Include SD 40P (if original return) or SD 40XP (if 
28     amended return) and make check payable to “School District Income Tax” ............ AMOUNT DUE                                                                      15.                88888888 00                       
29   
30  16. Overpayment (line 12 minus line 6a) .............................................................................................................  16.                                            8888888 00             
31  
32  17.  Original return only– amount of line 16 to be credited toward 2017 school district income tax liability ................   17.                                                                   8888888 00             
33
34  18.  REFUND (line 16 minus line 17) ..........................................................................................YOUR REFUND                              18.                           8888888 00             
35 Schedule       A – Traditional Tax Base School District Amounts (see instructions)
36   Complete this schedule only if fi ling a traditional tax base school district return.
37                                                                                                                                                                                 888888888 00                                  
   19. Ohio income tax base reported on line 5 of Ohio IT 1040 ..............................................................................  19.
38                                                                                                                                                                                                                  888888 00    
   20. Business income deduction add-back (see instructions) ...............................................................................  20.
39                                                                                                                                                                                 888888888 00                                  
    21. Total traditional tax base school district income (line 19 plus line 20) ............................................................  21.
40  
41  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.                                         888888888 00                                  
42
43                                                                                                                                                                                 888888888 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.
44  
   Schedule B – Earned Income Tax Base School District Amounts (see instructions)
45 Complete       this schedule only if fi ling an earned income tax base school district return.
46
   24. Wages and other compensation (see instructions) ........................................................................................  24.                               888888888 00                                  
47
48  
   25. Net earnings from self-employment to the extent included in Ohio adjusted gross income ...........................  25.                                                     888888888 00                                  
49                                                                                                                                                                                                                  888888 00    
    26. Depreciation expense adjustment (see instructions) .....................................................................................  26.
50
51  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.                                   888888888 00                                  
52
53      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.
54
55                                                                                                                                                                         NO Payment Included   Mail–                       to:
    Your signature                                                                            Date (MM/DD/YYYY)                                                                School District Income Tax
56                                                                                                                                                                                 P.O. Box 182197
57                                                                                                                                                                         Columbus, OH 43218-2197
    Spouse’s signature (see instructions)                                                     Phone number
58
                                                                                                                                                                           Payment Included   Mail–                          to:
59                                                                                                                                                                              School District Income Tax
               Preparer’s printed name (see instructions)      PTIN                            Phone number
60                                                                                                                                                                                 P.O. Box 182389
                                                                                                                                                                           Columbus, OH 43218-2389
61             Do you authorize your preparer to contact us regarding this return?                   XXYes                        No
62
63
                                                                                                                                       2016 SD 100 – page 2 of 2
64
65
66

Layout 

without grid

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

                                                                                              2016 SD 100 
                       Rev. 9/16          School District Income Tax Return
                                                                                                                                                                             16020110
     88 88 88                      Note: This form encompasses the SD 100 and amended SD 100X.

Is this an amended return?                                    X Yes         XNoIf yes, include SD RE (do not include a copy of the previously fi led return)
Is this a Net Operating Loss (NOL) carryback?                           X         Yes          X No                        If yes, include Schedule IT NOL
Taxpayer’s SSN (required)                          If deceased                              Spouse’s SSN (if fi ling jointly)                             If deceased     Enter school district # for 
                                                                                                                                                                             this return (see instructions).
888 88  8888                                            X                                     888 88  8888                                                          X
                                                        check box                                                                                             check box      SD#                    8888
First name                                                                              M.I.     Last name
JOHNXXXXXXXXXXX                                                                         Q        PUBL I CXXXXXXXXXXXXXX        

Spouse's fi rst name (only if married fi ling jointly)                                    M.I.     Last name
JANEXXXXXXXXXXX                                                                         Q        PUBL I CXXXXXXXXXXXXXX        
Mailing address (for faster processing, use a street address)
8888  CHERRY    LANEXXXXXXXXXXXXXXXXXXX
City                                                                                                                               State   ZIP code                 Ohio county (fi rst four letters)
CITYXXXXXXXXXXXXXXXX                                                                                                               OH        88888                  PICK
Home address (if different from mailing address) – do NOT include city or state                                                              ZIP code               Ohio county (fi rst four letters)
8888  BERRY AVEXXXXXXXXXX                                                                                                                    88888                  FRAN
Foreign country (if the mailing address is outside the U.S.)                                                                               Foreign postal code

JAPANXXXXXXXXXXXXXXX                                                                                                                         8888888
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 fi ling jointly)
     Full-year         Part-year resident               Full-year nonresident                                                      Full-year           Part-year resident                 Full-year nonresident 
X    resident        X of SD# above               X     of SD# above                                                          XXresident       X       of SD# above                       of SD# above
Enter date                                                                                                                     Enter date 
of nonresidency        88 88 88                   to    88 88 88                                                               of nonresidency         88 88 88           to              88 88 88
Filing Status – Check one (must match Ohio income tax return):                                                                 Tax Type – Check one (for an explanation, see the instructions)
X    Single, head of household or qualifying widow(er)                                                                         I am fi ling this return because during the taxable year I lived in a(n):
                                                                                                                              X    Traditional tax base school district. You must start with Schedule A, 
     Married fi ling jointly                                                                                                        line 19 on page 2 of this return.
X
                                                                                                                              X    Earned income tax base school district. You must start with Schedule 
     Married fi ling separately                                                                                                     B, line 24 on page 2 of this return.
X

1. School district taxable income: Traditional tax base:Enter on this line the amount you show on line 23.
                                   Earned income tax base:                              Enter on this line the amount you show on line 27 .... 1.                            888888888  00
2.  School district tax rate    .8888             times line 1 (rates found in the instructions) ...................................... 2.                                   88888888  00
3.  Senior citizen credit (you must be 65 or older to claim this credit; limit $50 per return) ............................... 3.                                                                    88 00
 4.  School district income tax liability (line 2 minus line 3; if less than -0-, enter -0-) .......................................... 4.                                                 888888  00
5.  Interest penalty on underpayment of estimated tax. Include Ohio IT/SD 2210 and the appropriate 
  worksheet if you annualize ............................................................................................................................. 5.                              888888  00
6.  Total school district income tax liability before withholding or estimated payments (line 4 plus line 5).... 6.                                                                        888888  00

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

                                                                                                                                               2016 SD 100 – page 1 of 2

                                                                                2016 SD 100 
                           Rev. 9/16          School District Income Tax Return
                                                                                                                                                                                   16020210
     SSN       888 88  8888                           SD#        8888

6a. Amount from line 6 on page 1 ...........................................................................................................................  6a.                                                888888 00    
  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 return ........ 7.                                                                                   888888 00    
  8. School district estimated and extension payments made (2016 SD 100ES and/or SD 40P) and credit 
    carryforward from previous year return .............................................................................................................  8.                                                     888888 00    
 9.   Amended return only         – amount previously paid with original/amended return ............................................... 9.                                                                       888888 00    

 10.  Total school district income tax payments (add lines 7, 8 and 9) ................................................................ 10.                                                                      888888 00    

11.   Amended return only         – overpayment previously requested on original/amended return ............................... 11.                                                                              888888 00    

12. Line 10 minus line 11 ........................................................................................................................................ 12.                                           888888 00    
                  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) ................................................................................................................................. 13.                        8888888 00             
 14. Interest and penalty due on late fi ling or late payment of tax (see instructions) ....................................................... 14.                                                     8888888 00             
 15.  TOTAL AMOUNT DUE (line 13 plus line 14). Include SD 40P (if original return) or SD 40XP (if 
    amended return) and make check payable to “School District Income Tax” ............ AMOUNT DUE                                                                      15.                88888888 00                       
  
 16. Overpayment (line 12 minus line 6a) .............................................................................................................  16.                                            8888888 00             
 
 17.  Original return only– amount of line 16 to be credited toward 2017 school district income tax liability ................   17.                                                                   8888888 00             

 18.  REFUND (line 16 minus line 17) ..........................................................................................YOUR REFUND                              18.                           8888888 00             
Schedule       A – Traditional Tax Base School District Amounts (see instructions)
  Complete this schedule only if fi ling a traditional tax base school district return.
19. Ohio income tax base reported on line 5 of Ohio IT 1040 ..............................................................................  19.                                 888888888 00                                  
20. Business income deduction add-back (see instructions) ...............................................................................  20.                                                                   888888 00    
 21. Total traditional tax base school district income (line 19 plus line 20) ............................................................  21.                                 888888888 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.                                         888888888 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.                                         888888888 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.                               888888888 00                                  
 
25. Net earnings from self-employment to the extent included in Ohio adjusted gross income ...........................  25.                                                     888888888 00                                  
 26. Depreciation expense adjustment (see instructions) .....................................................................................  26.                                                               888888 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.                                   888888888 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/YYYY)                                                               School District Income Tax
                                                                                                                                                                               P.O. Box 182197
                                                                                                                                                                        Columbus, OH 43218-2197
 Spouse’s signature (see instructions)                                                     Phone number
                                                                                                                                                                        Payment Included   Mail–                          to:
            Preparer’s printed name (see instructions)      PTIN                            Phone number                                                                    School District Income Tax
                                                                                                                                                                               P.O. Box 182389
                                                                                                                                                                        Columbus, OH 43218-2389
            Do you authorize your preparer to contact us regarding this return?                   XXYes                        No

                                                                                                                                    2016 SD 100 – page 2 of 2

General information 

regarding this form

              General Information (2016 SD 100):

1) Dimensions: 
  
  Target or Registration Marks - 6 mm X 6 mm. Follow grid layout for positioning.

  1D barcode (2 of 5 interleaved) - .375”H x 1.5”W. Follow grid layout for positioning. Center the barcode  
  number directly under the barcode.

  2D barcode (PDF 417) - See 2D instructions and schema. Follow grid layout for positioning. There is one 
  2D barcode for the SD 100.

2) 1D barcode - The last two numbers of the 1D barcode represent the vendor number. Use the same vendor 
number as you did for last year’s return. If you have a question about your barcode assignment, e-mail the Forms 
Unit at Forms@tax.state.oh.us. The fi rst six numbers are constant for this form (160201XX - 160202XX). 

  16 = tax year
  02 = SD 100 
  01-02 = page number 
  XX = vendor number (assigned to you by the Ohio Dept. of Taxation, Forms Unit)

    NOTE: The vendor number also serves as the fi rst two digits of the SSN in the test scenarios.

3) Use Arial font for the static text on the form.

4) Use monospaced Arial or similar monospaced san serif font for the variable data fi elds on the form.

5) Follow the grid layout for the variable data fi elds shown in red. Ensure that the tax year, target or reg-
istration marks, “For Department Use Only” area and the 1D and 2D barcodes follow grid layout.

6) Do not use commas, hyphens or decimals in the variable data fi elds except where shown in specs.

7)  All monetary fi elds must always show “00” in the cents fi eld even though there may not be a value for that line.

8) When a variable data fi eld refl ects a negative amount, make sure there is no space between the negative sign 
and the amount (for example: -888888888 00). The possible negative fi elds for this return are lines 12, 19, 21 
and 25. Do not hard-code negative signs.

9) Provide guidance to customers regarding duplex printing that instructs them to print pages 1 and 2 together. 
Taxpayers have fi led returns with pages 2 and 3 duplexed or a worksheet or software receipt on the back of a 
page of the return. This slows the processing of the tax return.

10) Generate the following message for customers: “Do not enclose other documentation unless it is specifi ed 
on the tax return or instructions.” Taxpayers often submit worksheets and receipts from the vendor product, 
which slows the processing of tax returns.

11) When the SD 100 is fi led as an amended return, please include the SD RE (Reason of Explanation and Cor-
rections), and if necessary, the IT NOL. Make sure that any barcodes on these returns represent your vendor 
number assignment. For example, if your last two digits of your 1D barcode are “05”, make sure that these are 
“05” also.

12) IMPORTANT NOTE: Add this statement to your software programs. It should print out with the taxpayer’s 
return. “Do not hand write in any corrections on the printed paper return. Hand writing in corrections will 

result in capturing incorrect data and delaying the processing of this income tax return. Make any cor-
rections to this income tax return within [the software program name], then print and mail.”

13) See the 2D barcode instructions for submission details.

                                                                                                                       SD RE
                                                                                                                       Rev. 10/16

                                                           16290101

               2016 SD RE – Reason and Explanation of Corrections
                                 Note: For amended school district return only
                          Complete the SD 100 (checking the amended return box) and include this 
                          form with documentation to support any adjustments to line items on the return. 
Taxpayer's SSN (required) 

First name                                            M.I. Last name

Reason(s):

   Net operating loss carryback (IMPORTANT: Be sure to complete       Ohio IT 1040, Schedule A, additions to income
   and include Ohio IT NOL, Net Operating Loss Carryback              Ohio IT 1040, Schedule A, deductions from income
   Worksheet, [available at tax.ohio.gov] and check the box on 
   the front of the SD 100 indicating that you are amending for a     Senior citizen credit claimed
   NOL.                                                               Ohio IT/SD 2210 interest penalty amount increased
   Federal adjusted gross income increased (see instructions)         Ohio IT/SD 2210 interest penalty amount decreased
   Federal adjusted gross income decreased (see instructions)*        School district withholding increased
   Change in amount of earned income (earned income tax base          School district withholding decreased
   fi lers)                                                            Estimated and/or SD 40P amount or previous year carryforward 
   Filing status changed*                                             overpayment increased
   Residency status changed                                           Estimated and/or SD 40P amount or previous year carryforward 
                                                                      overpayment decreased
   Exemptions increased (traditional tax base fi lers)*
   Exemptions decreased (traditional tax base fi lers)                 Amount paid with original fi ling did not equal amount reported 
                                                                      as paid with the original fi ling

*To avoid delays you must include a copy of your federal account transcript OR a copy of your federal amended income tax return with a 
copy of the IRS acceptance letter or refund check.
Detailed explanation of adjusted items (include additional sheet(s) if necessary):

E-mail address                                                        Telephone number

                                                  Federal Privacy Act Notice
   Because we require you to provide us with a Social Security number, the Federal Privacy Act of 1974 requires us to inform you that 
   providing us your Social Security 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. 

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