Reset Form
                                                  Tax Year                                                              SD 141X
     Department of                                                                                                      Rev. 11/07
hio  Taxation

SD 141X – Amended School District Employer’s Annual Reconciliation of Tax Withheld

     Ohio Withholding Account Number         Federal Employer Identifi cation Number                     Go paperless! File your 
                                                                                                        return through 
                                                                                                        Ohio Business Gateway: 
Name                                                                                                    www.obg.ohio.gov

Number and street                                                                                       Final return: Check the 
                                                                                                        box if out of business or 
City State ZIP code                                                                                     no more SD employees. 
                                                                                                        Explain on back.

1. Enter the total amount of school district income tax required to be withheld for 
ALL active school districts during the year ......................................................... 1.

2. Enter previous payments including any balance due paid with Ohio form SD 141; 
deduct any refund received from Ohio form SD 141 ..........................................           2.

3. If line 2 is LESS than line 1, subtract line 2 from line 1 and enter the balance of 
school district income tax due ....................................... AMOUNT YOU OWE                3.

4. If line 2 is GREATER than line 1, subtract line 1 from line 2 and enter the over-
payment of school district income tax ....................................YOUR REFUND                4.

NOTE: If you do not owe any taxes, write 0.00 in the space on line 3. If you have a balance due, make your check 
payable to: School District Income Tax. Complete the reverse side for each school district you withheld for, 
the tax liability for each district, and the total payment for each district.

I declare under penalties of perjury that to the best of my knowledge and belief this is a true, correct and complete return.

Signature of responsible person                                        Title                            Telephone number

Address, number and street                                             City                             State           ZIP code

Social Security number of responsible person                                                            Date

     For Departmental Use                         

                                                  Mail to: 
                                             School District Income Tax
                                                  P.O. BOX 182388
                                             Columbus, Ohio 43218-2388

INSTRUCTIONS: For all active school districts that you were required to withhold for, you must list the total tax liability for each district 
and the total payment for each district. If your payment does not equal the amount to be withheld, enter the net result for each district 
(over) or under in the net result column. Enter your net result on the front on line 3 or line 4.

               A               B            C                                                    D E
          School District Name School       School District Income Amount                          Underpayment/
                               District No. Tax Withheld           of Payment                      (Overpayment)