Rev. 09/14/22

Scan Specifications for the 

2022 Ohio SD 100 Bundle

Important Note

The following document (2022 Ohio SD 100 Bundle) contains grids 
for placement of information on this specific tax form. To accurately 
print, do not reduce the size, rotate or center this document. Doing so 
jeopardizes the integrity of the grid. When printing from Adobe Reader, 
select “None” for “Page Scaling,” which is under “Page Handling.”

The 2022 Ohio SD 100 Bundle test samples must be initially submitted 
by December 1, 2022 and approved no later than April 1, 2023. 

                        Ohio Department of Taxation

                        4485 Northland Ridge Blvd.

                        Columbus, OH 43229

                        tax.ohio.gov

                                General Information
1) Dimensions: 
  
  Target or Registration Marks - 0.2” diameter circles. 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 Ohio Department 
of Taxation assigned 2 digit vendor number. If you have a question about your barcode assignment, e-mail the 
Forms Unit at Forms@tax.state.oh.us. The first six numbers are constant for this form (220201XX - 220202XX). 
  22 = 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 fourth and fifth digits of the SSN in the test scenarios.
3) Use Arial or Courier font for the static text on the form. The static text for all target marks and header information
(target marks, logo, title and 1D barcode) must match grid. Note: Courier must be used for the static tax year 
in the form title on all pages.
4) Use Courier font for the variable data fields on the form.
5) Follow the grid layout for the variable data fields shown in red. Ensure that the tax year, target or 
registration 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 fields except where shown in specs.
7) The possible negative fields for this return are lines 12, 19, 21, 25 and 26. Do not hard-code negative signs.
8) For monetary lines, generate whole dollar values only. Monetary lines with no values are represented by only 
a carriage return in the 2D barcode and are blank on the printed form. 
9) Provide guidance to customers regarding duplex printing that instructs them to print pages 1 and 2 together. 
Taxpayers have filed 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 specified 
on the tax return or instructions.” Taxpayers often submit worksheets and receipts from the vendor product, 
which slows the processing of tax returns. Any other documents generated from the software must include a 1D 
barcode identifying it as additional information.  The preferred placement is centered on the top edge of the page 
within the print area, however placement at any location on the page will be accepted.  Always use the following 
1D barcode (2 of 5 interleaved).

   10211411
11) If income statements exceed the allotted amounts allowed on form SD WH, generate duplicate copies when 
applicable to accommodate any additional income statements. However, omit the standard 1D and 2D barcodes 
from the duplicate pages and include the 10211411 barcode indicated above.
12) When an amended SD 100 is filed, include the SD RE (Reason of Explanation and Corrections), and the IT 
NOL if applicable. Note: NOL carryback should not be allowed on the current year return. Make sure that the SD 
RE barcode on this return includes your assigned vendor number. For example, if your last two digits of your 1D 
barcode are “05”, make sure that the last two digits of the SD RE barcode is “05” also.

13) If the preparer files a paper return, form IT/SD Waiver must be included. Make sure that the IT/SD Waiver 
barcode on this return includes your assigned vendor number. For example, if your last two digits of your 1D 
barcode are “05”, make sure that the last two digits of the IT/SD Waiver barcode is “05” also.
14) For all balance due returns, generate the proper payment voucher.  For an original return use the Ohio SD 
40P and for an amended return use the Ohio SD 40XP.
15) 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 corrections to this income 
tax return within [the software program name], then print and mail.”

                         2D Barcode Instructions
                                        General Information
● The Ohio SD 100 bundle must be enabled for 2D barcode decoding
●A form enabled for 2D barcode should not allow users or practitioners the option to turn off/on the 
 2D barcode function
● The minimum error correction code level is 4
● Optimal dpi level is 300 dpi. The minimum dpi level is 200 dpi

                                 Size and Placement on the Form
● 2D barcode must be placed on each page of form in the designated area indicated in the grid layout
●The maximum size of the 2D barcode is 3.5 inches wide by 1 inch in height and must fit within the 
 designated space in the grid layout
● 2D barcode must not be bigger than the allocated area

                                           Barcode Layout
●Each field in the barcode is delimited by a single carriage return
 ○ <CR> equals single carriage return character
 ○This separates each piece of data so it may be identified and processed.
● Data included in the 2D barcode can be broken down into three general sections
     Header 
            Header Version Number
                  ●  Static for all barcodes, value is T1
            Developer Code
                  ●  A four-digit vendor code identifying the software developer whose application 
                    produced the barcode
            Jurisdiction
                  ●  Static for all barcodes, value is OH
            Description
                  ● A four-digit form identifier, specific to each form
            Spec Version
                  ● A one-digit specification version control number starting with the number zero
                  ● This number identifies the version of the specifications used to produce the form-
                    barcode
            Form Version
                  ●  A one-digit form version control number starting with the number one (1)
                  ●  This number will only be incremented when there are changes made that would 
                    affect the content of the barcode

    Date Generated
          ●  Included on page 1 only
          ●  Indicates date return was generated from the product
   Form Specific Data – Please see encoding schemas for form specific data
    ● All fields listed in the schema must be represented in the 2D barcode
    ●  Fields with values are represented by the data followed by a carriage return
    ●  Fields with no values are represented by a carriage return only; this results in two 
          adjacent carriage returns
   Trailer
    ● The last field in the barcode data stream is the trailer
    ●  The trailer is used to indicate the end of data has been reached
    ● A static string of *EOD* is used as the trailer value
 
Examples of 2D Barcode Data Streams (Long Forms)
    Header Version Number T1 <CR> 
    Developer Code 1111 <CR> 
    Jurisdiction OH <CR> 
    Description 2202 <CR> 
    Spec Version 0 <CR> 
    Form Version 1 <CR> 
    Date Generated 011823 <CR> 
    Line Item Specific Data IN <CR> 
    Line Item Specific Data IT40 <CR> 
    Line Item Specific Data 0 <CR> 
    Trailer *EOD* <CR>

   Examples of 2D Barcode Data Streams (Vouchers)
    Header                                                 2250899 <CR>
    Year                                                   0522 <CR>
    Primary Taxpayer’s SSN                                 123456789 <CR>
    Spouse’s SSN                                           987564321<CR>
    School District Number                                 2801<CR>
    First Three Letters of Primary Taxpayer’s SSN          CIT <CR>
    First Three Letters of Spouse’s SSN                    PUB <CR>
    Amount of Payment (including cents)                    12345678900 <CR>                  
    Trailer                                                *EOD* <CR>

                                         Submission Process
● Testing of Ohio SD 100 bundle packets commences on October 31, 2022 
● The deadline for an initial submission of SD 100 bundle test packets is December 1, 2002 
● The deadline for approval of Ohio SD 100 bundle test packets is April 18, 2023
● Test packets may be submitted by email to Forms@tax.state.oh.us
● The email subject line must include the vendor number, product name, tax year and form number in 
 that order e.g. 12_ABCTax_ 22_SD100
● Submissions must include
 ○One (1) full field sample in a PDF format
 ○Eighteen  (18) test scenarios for the SD 100 bundle provided by the Ohio Department of Taxation. 
    These test scenarios can include the following return, schedules, documents and vouchers: Ohio 
    SD 100, SD WH, SD RE, SD 40P, SD 40XP, IT/SD Waiver and others depending on the scenario. 
    Send only the forms that each scenario requires. Note: Make sure to send in the correct pay-
    ment voucher if a scenario requires it.
 ○Each    test scenario must be in a separate PDF using the following naming convention: vendor 
    number, product name, tax year, form number, test number. Example: 12_ABCTax_22_SD100_Test 1
●An  emailed confirmation is sent to the vendor indicating the packet was received
● Submissions missing any of the items above will be rejected

                                             Testing Process

● Test packets are reviewed in two (2) content areas- printed forms and 2D barcode data
● A submission is approved in its entirety once all sample documents pass in both areas

      Printed forms
●Vendor   full field matches template provided in the specifications
●All fields are present, formatted properly and aligned with grid layout
●Test scenarios contain values specified by Ohio Department of Taxation
 
      2D Barcode Data
● Barcodes read as valid
● All test scenarios can be decoded
● 2D barcode data matches data on printed forms

                                             Notifications

● Communications regarding submissions are sent from Forms@tax.state.oh.us to the vendor email 
 address(es) on file for the product
● If forms are released prior to approval vendors must include a visual indicator to alert the taxpayer 
 that the return cannot be filed.
●An  emailed confirmation is sent to the vendor indicating the packet was approved, at which point the 
 product is authorized to remove the indicator.
●An  email confirmation is sent to the vendor for packets that are rejected
 ○ Feedback is provided regarding the errors found
 ○Resubmit     packets must include all test scenarios and the full field return
 ○ After the third submission of test materials, the department cannot guarantee timeliness of the 
    review
●If a tax form changes before January 1, 2023 vendors will be notified and required to submit revised 
 test packets.

Grid layout

1 2 3 4 5 6 7 8 9 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                                                            Do not staple or paper clip.
4                                                                                                                        2022 Ohio SD 100 
5                                                                                                               School District Income Tax Return
6                                                                                                   Use only black ink/UPPERCASE letters. Use whole dollars only.                                                           22020110
7                                                       88 88 88                    File a separate Ohio SD 100 for each taxing school district in which you lived during the tax year.

8                                                         X  AMENDED RETURN -  Check here and include Ohio SD RE.                      X NOL CARRYBACK - Check here and include Schedule IT NOL.
9                                                         
10                                                      Primary taxpayer's SSN (required)       If deceased             Spouse’s SSN (if filing jointly)          If deceased                                             School district # 
11
12                                                        888 88 8888                                     X               888 88 8888                               X                                                         8888
13
                                                        First name                                                       M.I. Last name
14
15                                                        JOHNXXXXXXXXXXX                                                Q    PUBLICXXXXXXXXXXXXXXXX
16                                                      Spouse's first name (if filing jointly)                          M.I. Last name
17
18                                                        JANEXXXXXXXXXXX                                                Q    PUBLICXXXXXXXXXXXXXXXX

19                                                      Address line 1 (number and street) or P.O. Box
20
21                                                        8888 CHERRY LANEXXXXXXXXXXXXXXXXXXX
22                                                      Address line 2 (apartment number, suite number, etc.)
23
24                                                        APT 88 XXXXXXXXXXXXXXXXXXXXXXXXXXXX
25                                                      City                                                                            State             ZIP code    Ohio county (first four letters)
26
27                                                        CITYXXXXXXXXXXXXXXXX                                                          OH                88888       PICK
28                                                      Foreign country (if the mailing address is outside the U.S.)                    Foreign postal code
29
30                                                        JAPANXXXXXXXXXXXXXXX                                                          X8X8X8X
31                                                      Residency Status   – Check only one for primary                                Check only one for spouse (if filing jointly)
32                                                      X    Resident    X Part-year resident         X   Nonresident                  X Resident         X Part-year resident                                              X Nonresident
33
34                                                      Dates of                                                                       Dates of 
                                                        residency                                   to                                 residency                                                       to
35                                                                            88 88 88                    88 88 88                                        88 88 88                                                          88 88 88
36                                                      Filing Status – Check one (as reported on the Ohio IT 1040)                    Tax Type – Check one (see instructions)
37                                                           Single, head of household or qualifying widow(er)                                                      Start with line 19 of this return.
                                                                                                                                         Traditional tax base.
38                                                        X                                                                            X

                                                                                                                                         Earned income tax base. 
39                                                        X Married filing jointly                      Spouse’s SSN                   X                            Start with line 24 of this return.
40
41                                                        XMarried filing separately                888 88 8888
42
43                                                                                         Traditional tax base from line 23
                                                        1. School district taxable income: 
                                                                                           Earned income tax base from line 27 ...........................................................................1.                    
44                                                                                                                                                                                                                            888888888
                                                         
45                                                      2.  School district income tax liability: line 1 times tax rate  .8888   (see instructions for rate) ............................2.                                          88888888
46
47
                                                        3.  Senior citizen credit (you must be 65 or older to claim this credit; limit $50 per return) ............................................3.
48                                                                                                                                                                                                                                            88

49                                                      4.  Line 2 minus line 3 (if negative, enter zero) ................................................................................................................4.         88888888
50
                            Do not staple or paper clip.
51
                                                        5.  Interest penalty on underpayment of estimated tax (include Ohio IT/SD 2210)  .......................................................5.                                    
52                                                                                                                                                                                                                                    888888
53
                                                        6.  Total school district income tax liability before withholding or estimated payments (line 4 plus line 5).................6.                                         
54                                                                                                                                                                                                                                   88888888
55
56
57
58
59
60                                                                 Software vendors: Place 2D barcode in this location
61                                                                 Do not place a box around the 2D barcode. The box
62                                                                              is only here for placement purposes.
                                                                                                                                                                                                                            MM-DD-YY     Code
63
64                                                                                                                                                                     2022 SD 100 – page 1 of 2
65
66

1 2 3 4 5 6 7 8 9 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                                                  2022 Ohio SD 100 
5                                                  School District Income Tax Return
6                                                                                                                                                                                                                             22020210

7   SSN     888 88 8888                        SD# 8888
8
9  6a. Amount from line 6 on page 1 .................................................................................................................................6a.                                                          88888888
10
11   7. School district income tax withheld – Schedule of School District Withholding, part A, line 1 (include 
         schedule and income statements ) ........................................................................................................................7.                                                              
12                                                                                                                                                                                                                                88888888
     8. Estimated and extension payments (from Ohio SD 100ES and SD 40P), and credit carryforward 
13     from last year’s return ...............................................................................................................................................8.                                                  88888888
14
15   9.  Amended return only – amount previously paid with original and/or amended return ...........................................9.                                                                                           88888888
16
    10.  Total school district income tax payments (add lines 7, 8 and 9) ......................................................................10.
17                                                                                                                                                                                                                                88888888
18
19 11.   Amended return only – overpayment previously requested on original and/or amended return ..........................11.                                                                                                   88888888
20
   12. Line 10 minus line 11. Place a “-” in the box if negative ...................................................................................                                                                    .12.
21                                                                                                                                                                                                                                88888888
22                                                                                                                                                                                                                    -
23          If line 12 is MORE THAN line 6a, go to line 16. OTHERWISE, continue to line 13.
24 13. Tax due (line 6a minus line 12). If line 12 is negative, ignore the “-” and add line 12 to line 6a. .............................13.                                                                                       88888888
25
    
26  14. Interest due on late payment of tax (see instructions) ........................................................................................................14.                                                        88888888
27
    15. 
28       TOTAL AMOUNT DUE (line 13 plus line 14). Include Ohio SD 40P (if original return) or 
       Ohio SD 40XP (if amended return) and make check payable to “School District Income Tax” ......... AMOUNT DUE15.
29                                                                                                                                                                                                                                88888888
      
30  16. Overpayment (line 12 minus line 6a) ......................................................................................................................16.                                                             88888888
31
32  
    17.  Original return only – amount of line 16 to be credited toward next year’s school district income tax liability .................17.                                                                                     
33                                                                                                                                                                                                                                88888888

34  18.  REFUND (line 16 minus line 17) ................................................................................................. YOUR  REFUND18.                                                                        88888888
35
   Traditional Tax Base (lines 19 to 23)
36  

37 19. Ohio IT 1040, line 3 minus Ohio IT 1040, line 4. Place a “-” in the box if negative ......................................                                                                                     -  .19.     888888888
38
39  20. Business income deduction add-back (from Ohio Schedule of Adjustments, line 11) ............................................20.                                                                                               888888
40
41  21. Line 19 plus line 20. Place a “-” in the box if negative ..................................................................................                                                                   -  .21.     888888888
42
43 22. The portion of line 21 received while a nonresident of the school district entered above .......................................22.                                                                                        888888888
44 23. School district taxable income (line 21 minus line 22; if negative, enter zero). Enter here and on line 1 
45     of this return ............................................................................................................................................................23.                                             888888888
46  
   Earned Income Tax Base (lines 24 to 27)
47   24. Wages and other compensation received while a resident of the school district and included in modified 
    
48     adjusted gross income (see instructions) ................................................................................................................24.                                                               888888888
49  
   25. Net earnings from self-employment received while a resident of the school district and included in 
50     modified adjusted gross income (see instructions). Place a “-” in the box if negative ..................................                                                                                       -  .25.     888888888
51
52  26. Federal conformity adjustments (see instructions). Place a “-” in the box if negative ..................................                                                                                      -  .26.         888888
53
    27. School district taxable income (add lines 24, 25 and 26; if negative, enter zero). Enter here and on line 1 
54     of this return ............................................................................................................................................................27.                                             888888888
55
56 Sign Here (required): I have read this return. Under penalties of perjury, I declare that, to the best of my knowledge                                                                                             If your refund is $1.00 or less, no refund will be issued. 
   and belief, the return and all enclosures are true, correct and complete.                                                                                                                                          If you owe $1.00 or less, no payment is necessary.
57 Primary signature                                                     Phone number                                                                                                                                 NO Payment Included  –Mail to:
58  Spouse’s signature                                                          Date                                                                                                                                    Ohio Department of Taxation
59                                                                                                                                                                                                                           P.O. Box 182197
                                                                                                                                                                                                                        Columbus, OH  43218-2197
60 X Check here to authorize your preparer to discuss this return with the Department.
61                                                                                                                                                                                                                      Payment Included  –Mail to:
   Preparer's printed name                                                                                 Phone number                                                                                                 Ohio Department of Taxation
62                                                                                                                                                                                                                            P.O. Box 182389
63                                                                                                                                                                                                                      Columbus, OH  43218-2389
                                                  Preparer's TIN (PTIN)              P
                                                                                      88888888
64                                                                                                                                                                                                                      2022 SD 100 – page 2 of 2
65
66

1 2 3 4 5 6 7 8 9 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                                                 2022 Schedule of School
5                                                 District Withholding 
                                          Use only black ink/UPPERCASE letters. Use whole dollars only.                                                                 22360110
6
                               Complete a separate schedule for each SD 100 you file that reports school district withholding.
7
8                                                     Primary taxpayer’s SSN                                     School District #
9
10                                                    888 88 8888                                                8888
     List your and your spouse’s (if filing jointly) W-2 and 1099-R forms only if they have school district withholding. Enter “P” in the “P/S” box if the form is 
11   the primary taxpayer’s and enter “S” if it is the spouse’s. If the Ohio ID number on a statement has 9 digits, enter only the first 8 digits. Complete additional 
12   copies if necessary. Place state copies of your income statements after the last page of your return.
13   Important: On occasion, employers will report school district withholding in box 14 of the W-2 instead of the “local” boxes. In this case, enter the school
14   district number and the withholding amount in the appropriate fields and report the Ohio state wages from box 16 as the school district wage amount.
15   Part A - Total Withholding
16
     1. Total of all school district income tax withheld for the school district entered above. Enter here and on
17     line 7 of your SD 100 ....................................................................................................................................... 1. 88888888
18
19   Part B - W-2s
20   1. P/S Box b - EIN                           Box 1 - Wages, tips, other compensation                        Box 2 - Federal income tax withheld
21
        X   888888888                             888888888                                                      88888888
22
23          Box 15 - Employer’s Ohio ID number    Box 18 - School district wages                                                                                        Box 19 - School district tax
24
            88888888
25                                                888888888                                                                                                             88888888
26   2. P/S Box b - EIN                           Box 1 - Wages, tips, other compensation                        Box 2 - Federal income tax withheld
            888888888                             888888888
27      X                                                                                                        88888888
28
29          Box 15 - Employer’s Ohio ID number    Box 18 - School district wages                                                                                        Box 19 - School district tax
30
            88888888                              888888888                                                                                                             88888888
31
32   3. P/S Box b - EIN                           Box 1 - Wages, tips, other compensation                        Box 2 - Federal income tax withheld
            888888888                             888888888
33      X                                                                                                        88888888
34
35          Box 15 - Employer’s Ohio ID number    Box 18 - School district wages                                                                                        Box 19 - School district tax
36
            88888888                              888888888                                                                                                             88888888
37
38   4. P/S Box b - EIN                           Box 1 - Wages, tips, other compensation                        Box 2 - Federal income tax withheld
            888888888                             888888888
39      X                                                                                                        88888888
40
41          Box 15 - Employer’s Ohio ID number    Box 18 - School district wages                                                                                        Box 19 - School district tax
42
            88888888                              888888888                                                                                                             88888888
43
44   5. P/S Box b - EIN                           Box 1 - Wages, tips, other compensation                        Box 2 - Federal income tax withheld
            888888888                             888888888
45      X                                                                                                        88888888
46
     
47          Box 15 - Employer’s Ohio ID number    Box 18 - School district wages                                                                                        Box 19 - School district tax
48
            88888888                              888888888                                                                                                             88888888
49
50   Part C - 1099-Rs
51   1. P/S Payer’s TIN                           Box 1 - Gross distribution                                     Box 4 - Federal income tax withheld
52
53      X   888888888                             888888888                                                      88888888
54          Box 15 - Payer’s Ohio number          Box 19 - School district distribution                                                                                 Box 17 - School district tax
55
56          88888888                              888888888                                                                                                             88888888
57  
58
59
60             Software vendors: Place 2D barcode in this location
61             Do not place a box around the 2D barcode. The box
62                        is only here for placement purposes.
63
64                                                                                      2022 Schedule of SD Withholding – page 1 of 1
65
66

1 2 3 4 5 6 7 8 9 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                                                      Ohio SD RE
5                                                  2022 
6                                                  Explanation of Corrections
                                                                                                                                  22290110
7                                                  Note: For amended school district return only
8                                                  Primary taxpayer's SSN
9
10                                                 888 88 8888
11
12 Complete the Ohio SD 100 and indicate that it is amended by checking the box at the top of page 1. You must include this form and 
   documentation to support the adjustments on your amended return.  
13
14 Reason(s):

15 X Ohio income tax base change                                     X  Filing status changed 
16       (Traditional tax base only)
17                                                                   X  Residency status changed
18 X Business income deduction add-back change 
19       (Traditional tax base only)                                 X  Senior citizen credit claimed
20  
21 X Wages and other compensation change                             X  Other (describe the reason below)
22       (Earned income tax base only)
23
24 X Net self-employment income change 
25       (Earned income tax base only)
26  
27 If the changes to your school district return are due to an amended Ohio IT 1040, file your amended SD 100 at the same time. See the 
28 filing tips on the next page as well as the Ohio Individual and School District Income tax instructions.
29 Detailed explanation of adjusted items (include additional sheet[s] if necessary):
30
31 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
32 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
33 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
34 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
35 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
36 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 
37 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
38 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
39 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
40 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
41 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
42 E-mail address                                                    Telephone number
43
44
45 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 
46 with 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.
47
48
49
50
51
52
53
54
55
56
57
58
59
60           Software vendors: Place 2D barcode in this location
61           Do not place a box around the 2D barcode. The box 
62                is only here for placement purposes.
63
64                                                                                                                                2022 SD RE – page 1 of 2
65
66

   1 2 3 4 5 6 7 8 9 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
                                                                                                                                                      •  Do NOT send cash
45                                                                                  88 88 88                               Tax Year                   •  Do NOT fold, staple,                    School district
46         OHIO SD 40P
                                                                                                                                                          or paper clip                                number
47         Original School District Income Tax Payment Voucher  
48                                                                                                                      2022                                                                           2801
49                                                                                                                                                                                Use UPPERCASE letters
50         John Q. CitizenXXXXXXXXXXXXXXXXXXXX                                                                                                                                 to print   the first three letters       of
51
                                                                                                                                                                                  Taxpayer’s              Spouse’s last name
52         Jane E. PublicXXXXXXXXXXXXXXXXXXXXX                                                                                                                                    last name                     (if filing jointly)
53
54                                                                                                                                                                                   CIT                               PUB
           1234 Any StreetXXXXXXXXXXXXXXXXXXXX
55                             
56
57                                                                                                                                  Taxpayer’s SSN
           Any CityXXXXXXXXXXXX, US 12345-2345
58         Make payment payable to: School District Income Tax                                                       99                                                              123 45 6789
59         Mail to: Ohio Department of Taxation,                                                                                    Spouse’s SSN
           P.O. Box 182389, Columbus, OH 43218-2389                                                                                 (only if joint filing)                           987 65 4321
60
61                                                                                                                         Amount of
                                                                                                                              Payment                           $ 123456789.00
62
63                                                                                           123456789 3 0522 3 987654321 3 2801 9 508                                                                        
64
65
66

   1 2 3 4 5 6 7 8 9 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
45                                                                                                                         Tax Year                   •  Do NOT send cash
           OHIO SD 40XP                                                             88 88 88                                                          •  Do NOT fold, staple,                    School district
46                                                                                                                                                        or paper clip                                number
47         Amended School District Income Tax Payment Voucher  
48                                                                                                                      2022                                                                           2801
49                                                                                                                                                                                Use UPPERCASE letters
50                                                                                                                                                                             to print   the first three letters       of
           John Q. CitizenXXXXXXXXXXXXXXXXXXXX  
51
                                                                                                                                                                                  Taxpayer’s              Spouse’s last name
52         Jane E. PublicXXXXXXXXXXXXXXXXXXXXX                                                                                                                                    last name                     (if filing jointly)
53
54         1234 Any StreetXXXXXXXXXXXXXXXXXXXX                                                                                                                                       CIT                               PUB
55
56         Any CityXXXXXXXXXXXX, US 12345-2345
57                                                                                                                   99                Taxpayer’s SSN                                123 45 6789
58         Make payment payable to: School District Income Tax 
59         Mail to: Ohio Department of Taxation,                                                                                       Spouse’s SSN
           P.O. Box 182389, Columbus, OH 43218-2389                                                                                    (only if joint filing)                        987 65 4321
60
61                                                                                                                         Amount of
                                                                                                                              Payment                           $ 123456789.00
62
63                                                                                           123456789 3 0522 3 987654321 3 2801 9 515                                                                        
64
65
66

Layout 

without grid

Do not staple or paper clip.
2022 Ohio SD 100 
School District Income Tax Return
Use only black ink/UPPERCASE letters. Use whole dollars only. 22020110
88 88 88 File a separate Ohio SD 100 for each taxing school district in which you lived during the tax year.

 X AMENDED RETURN -  Check here and include Ohio SD RE. X NOL CARRYBACK - Check here and include Schedule IT NOL.
 
Primary taxpayer's SSN (required) If deceased Spouse’s SSN (if filing jointly) If deceased School district # 
888 88 8888 X 888 88 8888 X 8888

First name M.I. Last name
JOHNXXXXXXXXXXX Q PUBLICXXXXXXXXXXXXXXXX
Spouse's first name (if filing jointly) M.I. Last name
JANEXXXXXXXXXXX Q PUBLICXXXXXXXXXXXXXXXX

Address line 1 (number and street) or P.O. Box
8888 CHERRY LANEXXXXXXXXXXXXXXXXXXX
Address line 2 (apartment number, suite number, etc.)
APT 88 XXXXXXXXXXXXXXXXXXXXXXXXXXXX
City State ZIP code Ohio county (first four letters)
CITYXXXXXXXXXXXXXXXX OH 88888 PICK
Foreign country (if the mailing address is outside the U.S.) Foreign postal code
JAPANXXXXXXXXXXXXXXX X8X8X8X
Residency Status   – Check only one for primary Check only one for spouse (if filing jointly)
X Resident X Part-year resident X Nonresident X Resident X Part-year resident X Nonresident
Dates of Dates of 
residency 88 88 88 to 88 88 88 residency 88 88 88   to 88 88 88
Filing Status – Check one (as reported on the Ohio IT 1040) Tax Type – Check one (see instructions)
Single, head of household or qualifying widow(er) Traditional tax base. Start with line 19 of this return.
X X

X Married filing jointly  Spouse’s SSN X Earned income tax base. Start with line 24 of this return.
X Married filing separately888 88 8888
1. School district taxable income:Traditional tax basefrom line 23
   Earned income tax base from line 27 ...........................................................................1.   888888888
 
2.  School district income tax liability: line 1 times tax rate  .8888 (see instructions for rate) ............................2.   88888888

3.  Senior citizen credit (you must be 65 or older to claim this credit; limit $50 per return) ............................................3. 88

4.  Line 2 minus line 3 (if negative, enter zero) ................................................................................................................4.  88888888
Do not staple or paper clip.
5.  Interest penalty on underpayment of estimated tax (include Ohio IT/SD 2210)  .......................................................5.  888888

6.  Total school district income tax liability before withholding or estimated payments (line 4 plus line 5).................6.   88888888

Software vendors: Place 2D barcode in this location
Do not place a box around the 2D barcode. The box
is only here for placement purposes.
MM-DD-YY Code

 2022 SD 100 – page 1 of 2

                                                2022 Ohio SD 100 
                                                School District Income Tax Return
                                                                                                                                                                                                                           22020210

 SSN     888 88 8888                        SD# 8888

6a. Amount from line 6 on page 1 .................................................................................................................................6a.                                                          88888888
  7. School district income tax withheld – Schedule of School District Withholding, part A, line 1 (include 
      schedule and income statements ) ........................................................................................................................7.                                                              88888888
  8. Estimated and extension payments (from Ohio SD 100ES and SD 40P), and credit carryforward 
    from last year’s return ...............................................................................................................................................8.                                                  88888888

  9.  Amended return only – amount previously paid with original and/or amended return ...........................................9.                                                                                           88888888

 10.  Total school district income tax payments (add lines 7, 8 and 9) ......................................................................10.                                                                               88888888

11.   Amended return only – overpayment previously requested on original and/or amended return ..........................11.                                                                                                   88888888

12. Line 10 minus line 11. Place a “-” in the box if negative ...................................................................................                                                                  -  .12.     88888888
            If line 12 is MORE THAN line 6a, go to line 16. OTHERWISE, continue to line 13.
13. Tax due (line 6a minus line 12). If line 12 is negative, ignore the “-” and add line 12 to line 6a. .............................13.                                                                                       88888888
 
 14. Interest due on late payment of tax (see instructions) ........................................................................................................14.                                                        88888888
 15.  TOTAL AMOUNT DUE (line 13 plus line 14). Include Ohio SD 40P (if original return) or 
    Ohio SD 40XP (if amended return) and make check payable to “School District Income Tax” ......... AMOUNT DUE15.                                                                                                           88888888
   
 16. Overpayment (line 12 minus line 6a) ......................................................................................................................16.                                                             88888888
 
 17.  Original return only – amount of line 16 to be credited toward next year’s school district income tax liability .................17.                                                                                     88888888

 18.  REFUND (line 16 minus line 17) ................................................................................................. YOUR  REFUND18.                                                                        88888888
Traditional Tax Base (lines 19 to 23)

19. Ohio IT 1040, line 3 minus Ohio IT 1040, line 4. Place a “-” in the box if negative ......................................                                                                                     -  .19.    888888888

 20. Business income deduction add-back (from Ohio Schedule of Adjustments, line 11) ............................................20.                                                                                               888888

 21. Line 19 plus line 20. Place a “-” in the box if negative ..................................................................................                                                                   -  .21.    888888888

22. The portion of line 21 received while a nonresident of the school district entered above .......................................22.                                                                                       888888888
23. School district taxable income (line 21 minus line 22; if negative, enter zero). Enter here and on line 1 
    of this return ............................................................................................................................................................23.                                            888888888
 
Earned Income Tax Base (lines 24 to 27)
  24. Wages and other compensation received while a resident of the school district and included in modified 
 
    adjusted gross income (see instructions) ................................................................................................................24.                                                              888888888
 
25. Net earnings from self-employment received while a resident of the school district and included in 
    modified adjusted gross income (see instructions). Place a “-” in the box if negative ..................................                                                                                       -  .25.    888888888

 26. Federal conformity adjustments (see instructions). Place a “-” in the box if negative ..................................                                                                                      -  .26.         888888
 27. School district taxable income (add lines 24, 25 and 26; if negative, enter zero). Enter here and on line 1 
    of this return ............................................................................................................................................................27.                                            888888888
Sign Here (required): I have read this return. Under penalties of perjury, I declare that, to the best of my knowledge                                                                                             If your refund is $1.00 or less, no refund will be issued. 
and belief, the return and all enclosures are true, correct and complete.                                                                                                                                          If you owe $1.00 or less, no payment is necessary.
Primary signature                                                     Phone number                                                                                                                                NO Payment Included  –Mail to:
 Spouse’s signature                                                          Date                                                                                                                                    Ohio Department of Taxation
                                                                                                                                                                                                                          P.O. Box 182197
                                                                                                                                                                                                                     Columbus, OH  43218-2197
      Check here to authorize your preparer to discuss this return with the Department.
X                                                                                                                                                                                                                    Payment Included  –Mail to:
Preparer's printed name                                                                                 Phone number                                                                                                 Ohio Department of Taxation
                                                                                                                                                                                                                           P.O. Box 182389
                                                                                                                                                                                                                     Columbus, OH  43218-2389
                                               Preparer's TIN (PTIN)              P
                                                                                       88888888
                                                                                                                                                                                                                     2022 SD 100 – page 2 of 2

                                               2022 Schedule of School
                                               District Withholding 
                                       Use only black ink/UPPERCASE letters. Use whole dollars only.                                                                 22360110
                            Complete a separate schedule for each SD 100 you file that reports school district withholding.
                                                   Primary taxpayer’s SSN                                     School District #
                                                   888 88 8888                                                8888
  List your and your spouse’s (if filing jointly) W-2 and 1099-R forms only if they have school district withholding. Enter “P” in the “P/S” box if the form is 
  the primary taxpayer’s and enter “S” if it is the spouse’s. If the Ohio ID number on a statement has 9 digits, enter only the first 8 digits. Complete additional 
  copies if necessary. Place state copies of your income statements after the last page of your return.
  Important: On occasion, employers will report school district withholding in box 14 of the W-2 instead of the “local” boxes. In this case, enter the school
  district number and the withholding amount in the appropriate fields and report the Ohio state wages from box 16 as the school district wage amount.
  Part A - Total Withholding
  1. Total of all school district income tax withheld for the school district entered above. Enter here and on
    line 7 of your SD 100 ....................................................................................................................................... 1. 88888888
  Part B - W-2s
  1. P/S Box b - EIN                           Box 1 - Wages, tips, other compensation                        Box 2 - Federal income tax withheld
     X   888888888                             888888888                                                      88888888
         Box 15 - Employer’s Ohio ID number    Box 18 - School district wages                                                                                        Box 19 - School district tax
         88888888                              888888888                                                                                                             88888888
  2. P/S Box b - EIN                           Box 1 - Wages, tips, other compensation                        Box 2 - Federal income tax withheld
     X   888888888                             888888888                                                      88888888
         Box 15 - Employer’s Ohio ID number    Box 18 - School district wages                                                                                        Box 19 - School district tax
         88888888                              888888888                                                                                                             88888888
  3. P/S Box b - EIN                           Box 1 - Wages, tips, other compensation                        Box 2 - Federal income tax withheld
     X   888888888                             888888888                                                      88888888
         Box 15 - Employer’s Ohio ID number    Box 18 - School district wages                                                                                        Box 19 - School district tax
         88888888                              888888888                                                                                                             88888888
  4. P/S Box b - EIN                           Box 1 - Wages, tips, other compensation                        Box 2 - Federal income tax withheld
     X   888888888                             888888888                                                      88888888
         Box 15 - Employer’s Ohio ID number    Box 18 - School district wages                                                                                        Box 19 - School district tax
         88888888                              888888888                                                                                                             88888888
  5. P/S Box b - EIN                           Box 1 - Wages, tips, other compensation                        Box 2 - Federal income tax withheld
     X   888888888                             888888888                                                      88888888
  
         Box 15 - Employer’s Ohio ID number    Box 18 - School district wages                                                                                        Box 19 - School district tax
         88888888                              888888888                                                                                                             88888888

  Part C - 1099-Rs
  1. P/S Payer’s TIN                           Box 1 - Gross distribution                                     Box 4 - Federal income tax withheld
     X   888888888                             888888888                                                      88888888
         Box 15 - Payer’s Ohio number          Box 19 - School district distribution                                                                                 Box 17 - School district tax
         88888888                              888888888                                                                                                             88888888
 
            Software vendors: Place 2D barcode in this location
            Do not place a box around the 2D barcode. The box
                       is only here for placement purposes.

                                                                                     2022 Schedule of SD Withholding – page 1 of 1

                                                2022 Ohio SD RE
                                                Explanation of Corrections
                                                                                                                               22290110
                                                Note: For amended school district return only
                                                Primary taxpayer's SSN
                                                888 88 8888

Complete the Ohio SD 100 and indicate that it is amended by checking the box at the top of page 1. You must include this form and 
documentation to support the adjustments on your amended return.  
Reason(s):

X Ohio income tax base change                                     X  Filing status changed 
      (Traditional tax base only)
                                                                  X  Residency status changed
X Business income deduction add-back change 
      (Traditional tax base only)                                 X  Senior citizen credit claimed
 
X Wages and other compensation change                             X  Other (describe the reason below)
      (Earned income tax base only)

X Net self-employment income change 
      (Earned income tax base only)
 
If the changes to your school district return are due to an amended Ohio IT 1040, file your amended SD 100 at the same time. See the 
filing tips on the next page as well as the Ohio Individual and School District Income tax instructions.
Detailed explanation of adjusted items (include additional sheet[s] if necessary):
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
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 
with 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.

          Software vendors: Place 2D barcode in this location
          Do not place a box around the 2D barcode. The box 
               is only here for placement purposes.

                                                                                                                               2022 SD RE – page 1 of 2

                                                              •  Do NOT send cash
                                       88 88 88      Tax Year •  Do NOT fold, staple,           School district
OHIO SD 40P
                                                                    or paper clip               number
Original School District Income Tax Payment Voucher  
                                                     2022                                             2801
                                                                                  Use UPPERCASE letters
John Q. CitizenXXXXXXXXXXXXXXXXXXXX                                               to print the first three lettersof
                                                                                  Taxpayer’s          Spouse’s last name
Jane E. PublicXXXXXXXXXXXXXXXXXXXXX                                               last name           (if filing jointly)

1234 Any StreetXXXXXXXXXXXXXXXXXXXX                                                  CIT                    PUB

Any CityXXXXXXXXXXXX, US 12345-2345
                                                        Taxpayer’s SSN
Make payment payable to: School District Income Tax  99                               123 45 6789
Mail to: Ohio Department of Taxation,                   Spouse’s SSN
P.O. Box 182389, Columbus, OH 43218-2389                (only if joint filing)        987 65 4321
                                                     Amount of
                                                     Payment                   $ 123456789.00
                                         123456789 3 0522 3 987654321 3 2801 9 508                     

                                                    Tax Year •  Do NOT send cash              School district
OHIO SD 40XP                          88 88 88               •  Do NOT fold, staple, 
                                                                or paper clip                 number
Amended School District Income Tax Payment Voucher  
                                                    2022                                            2801
                                                                                Use UPPERCASE letters
                                                                                to print the first three lettersof
John Q. CitizenXXXXXXXXXXXXXXXXXXXX  
                                                                                Taxpayer’s          Spouse’s last name
Jane E. PublicXXXXXXXXXXXXXXXXXXXXX                                             last name           (if filing jointly)

1234 Any StreetXXXXXXXXXXXXXXXXXXXX                                                CIT                    PUB

Any CityXXXXXXXXXXXX, US 12345-2345
                                                    99 Taxpayer’s SSN                123 45 6789
Make payment payable to: School District Income Tax 
Mail to: Ohio Department of Taxation,                  Spouse’s SSN
P.O. Box 182389, Columbus, OH 43218-2389               (only if joint filing)        987 65 4321
                                                    Amount of
                                                    Payment                   $ 123456789.00
                                         123456789 3 0522 3 987654321 3 2801 9 515