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                                                                       2016 SD 100 
                    Rev. 9/16
                                         School District Income Tax Return                                                                                         
                                  Note: This form encompasses the SD 100 and amended SD 100X.

Is this an amended return?        Yes         No  If yes, include SD RE (do not include a copy of the previously fi led return) 
Is this a Net Operating Loss (NOL) carryback?               Yes         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).
                                                  check box                                                                             check box                  SD#
First name                                                        M.I. Last name

Spouse's fi rst name (only if married fi ling jointly)              M.I. Last name

Mailing address (for faster processing, use a street address)

City                                                                                   State         ZIP code                                                Ohio county (fi rst four letters)

Home address (if different from mailing address) – do NOT include city or state                         ZIP code                                             Ohio county (fi rst four letters)

Foreign country (if the mailing address is outside the U.S.)                                Foreign postal code

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

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

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

                                                                                                              2016 SD 100 – pg. 1 of 2



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                                                                2016 SD 100 
                      Rev. 9/16               School District Income Tax Return
                                                                                                                                                                                    
   SSN                                        SD#
                                                                                                                                                                                                        00
6a. Amount from line 6 on page 1 ....................................................................................................................6a.                                               .
 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                                                                                               00
    return ............................................................................................................................................................7.                              .
 8. School district estimated and extension payments made (2016 SD 100ES and/or SD 40P) and credit                                                                                                      00
    carryforward from previous year return ........................................................................................................8.                                                  .
                                                                                                                                                                                                        00
 9. Amended return only – amount previously paid with original/amended return ..........................................9.                                                                             .
                                                                                                                                                                                                        00
 10. Total school district income tax payments (add lines 7, 8 and 9) .........................................................10.                                                                     .
                                                                                                                                                                                                        00
11.  Amended return only – overpayment previously requested on original/amended return ........................11.                                                                                     .
                                                                                                                                                                                                        00
12. Line 10 minus line 11. Place a negative sign (“-”) before the fi gure if the amount is less than -0- ....................12.                                                                        .
              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). If line 12 is negative, ignore the negative sign (“-”) and add line 12                                                                                       00
    to line 6a .....................................................................................................................................................13.                                .
                                                                                                                                                                                                        00
 14. Interest and penalty due on late fi ling or late payment of tax (see instructions) ..................................................14.                                                           .
 15. TOTAL AMOUNT DUE (line 13 plus line 14). Include SD 40P (if original return) or SD 40XP (if                                                                                                        00
    amended return) and make check payable to “School District Income Tax” ........ AMOUNT DUE15.                                                                                                     .
                                                                                                                                                                                                        00
 16. Overpayment (line 12 minus line 6a) .........................................................................................................16.                                                  .
 
                                                                                                                                                                                                        00
 17. Original return only – amount of line 16 to be credited toward 2017 school district income tax liability ............17.                                                                          .
                                                                                                                                                                                                        00
 18. REFUND (line 16 minus line 17) .................................................................................... YOUR  REFUND18.                                                              .
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. Place a negative sign (“-“) before the fi gure
                                                                                                                                                                                                        00
    if the amount is less than -0- ......................................................................................................................19.                                           .
                                                                                                                                                                                                        00
 20. Business income deduction add-back (see instructions) ...........................................................................20.                                                              .
 21. Total traditional tax base school district income (line 19 plus line 20). Place a negative sign (“-“) before 
                                                                                                                                                                                                        00
   the gure if the amount is less than -0- ......................................................................................................21.                                                 .
 22. The amount of traditional tax base school district income from line 21, if any, that you earned while 
                                                                                                                                                                                                        00
  not a resident of the school district whose number you entered on this return .........................................22.                                                                           .
23. School district taxable income (line 21 minus line 22; if less than -0-, enter -0-). Enter here and on 
                                                                                                                                                                                                        00
    line 1 of this return ......................................................................................................................................23.                                    .
 
Schedule B – Earned Income Tax Base School District Amounts (see instructions)
Complete      this schedule only if ling an earned income tax base school district return.
                                                                                                                                                                                                        00
  24. Wages and other compensation (see instructions) ....................................................................................24.                                                          .
25. Net earnings from self-employment to the extent included in Ohio adjusted gross income. Place 
                                                                                                                                                                                                        00
    a negative sign (“-“) before the fi gure if the amount is less than -0- ...........................................................25.                                                              .
                                                                                                                                                                                                        00
 26. Depreciation expense adjustment (see instructions) .................................................................................26.                                                           .
 27. School district taxable income (add lines 24, 25 and 26; if less than -0-, enter -0-). Enter here and on 
                                                                                                                                                                                                        00
    line 1 of this return ......................................................................................................................................27.                                    .

   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/YY)                                                                              School District Income Tax
                                                                                                                                                                            P.O. Box 182197
  Spouse’s signature (see instructions)                                    Phone number                                                                                 Columbus, OH 43218-2197
                                                                                                                                                                         Payment Included  Mail to:
                                                                                                                                                                         School District Income Tax
       Preparer’s  printed name (see instructions)   PTIN                   Phone number                                                                                    P.O. Box 182389
       Do you authorize your preparer to contact us regarding this return?            Yes                                No                                              Columbus, OH 43218-2389

                                                                                                                            2016 SD 100 – pg. 2 of 2



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        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 
SD 40P                                                     OTHERWISE ATTACH                                         Do NOT fold check or voucher.
School District Income Tax Payment Voucher                 YOUR PAYMENT TO 
                                                                       THIS VOUCHER.      2016SP                    Use UPPERCASE letters
                                                           DO NOT SEND CASH.
                                                                                                                    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 fi ling)
Spouse’s fi rst name (only if joint fi ling) M.I.   Last name

Address                                                                                            Your SSN

                                                                                          Spouse’s SSN
City, state, ZIP code                                                                              (if joint fi ling)

                                                                                          Amount of
If you are sending this voucher and paper check or money order (payable to School 
District Income Tax) with or separately from your school district income tax return, mail Payment         $                         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.

                                           508



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           Electronic Payment Available                                                                              2016 SD 40XP
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 
SD 40XP                                                            OTHERWISE ATTACH                                  Do NOT fold check or voucher.
Amended School District Income Tax Payment Voucher                 YOUR PAYMENT TO 
                                                                   THIS VOUCHER.           2016SP
                                                                   DO NOT SEND CASH.                                 Use UPPERCASE letters
                                                                                                                     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   (if joint fi ling)
Spouse’s fi rst name (only if joint fi ling) M.I.   Last name

Address                                                                                             Your SSN

                                                                                           Spouse’s SSN
City, state, ZIP code                                                                               (if joint fi ling)

If you are sending this voucher and paper check or money order (payable to School District Amount of
Income Tax) with or separately from your amended school district income tax return, mail   Payment         $                              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.

                                           515



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                                                                                                                        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 Schedule,     Ohio IT 1040, Schedule A, deductions from income
   [available at tax.ohio.gov] and check the box on the front of the 
   SD 100 indicating that you are amending for a NOL.                  Senior citizen credit claimed
   Federal adjusted gross income increased                             Ohio IT/SD 2210 interest penalty amount increased
   Federal adjusted gross income decreased*                            Ohio IT/SD 2210 interest penalty amount decreased
   Change in amount of earned income (earned income tax base           School district withholding increased
   fi lers)                                                             School district withholding decreased
   Filing status changed*                                              Estimated and/or SD 40P amount or previous year carryforward 
   Residency status changed                                            overpayment increased
                                                                       Estimated and/or SD 40P amount or previous year carryforward 
   Exemptions increased (traditional tax base fi lers)*                 overpayment decreased
   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 federal 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. 

                                                           - 1 -






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