Form Sd 101 2004 - Employer'S Payment Of School District Income Tax Withheld - State Of Ohio
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1
2E
’
P
S
D
I
T
W
MPLOYER
S
AYMENT OF
CHOOL
ISTRICT
NCOME
AX
ITHHELD
Ohio Withholding Acct. No.
TIN
Payment Due Date
SD Number
School District Name
Tax Due
.
For the Period Ending
2004
.
SD 101
FEIN
.
Rev. 11/03
.
.
F
S
U
O
Make
OR
TATE
SE
NLY
remittance
.
payable to
School District
Income Tax
.
and mail to:
Ohio
.
Department of
Taxation, P.O.
I declare under penalties of perjury that this return, including any
Box 182388,
.
accompanying schedules and statements, has been examined by
Columbus, OH
me and to the best of my knowledge and belief is a true, correct
43218-2388
and complete return and report.
Total Tax Due
,
,
$
(Pay this amount)
One check only
Signature
Date
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