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 
SchoolSD 40PDistrict Income Tax Payment Voucher           OTHERWISEYOUR PAYMENTATTACHTO                            Do NOT fold check or voucher. 
                                                          DOTHISNOTVOUCHER.SEND CASH.     2016SP                      Use UPPERCASE letters
l,l,,l,,ll,,,l,l,,,lll,,l,,,,ll,ll,,ll,,,,11,,l,l,,I                                                                  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 
District Income Tax) with or separately from your school district income tax return, mail Payment 
If you are sending this voucher and paper check or money order (payable to School                         $                             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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