Form Sd 141x - Amended School District Employer'S Annual Reconciliation Of Tax Withheld

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hio
Tax Year
SD 141X
Department of
Rev. 11/07
Taxation
SD 141X – Amended School District Employer’s Annual Reconciliation of Tax Withheld
Ohio Withholding Account Number
Federal Employer Identifi cation Number
Go paperless! File your
return through
Ohio Business Gateway:
Name
Number and street
Final return: Check the
box if out of business or
no more SD employees.
City
State
ZIP code
Explain on back.
1. Enter the total amount of school district income tax required to be withheld for
1.
ALL active school districts during the year .........................................................
2. Enter previous payments including any balance due paid with Ohio form SD 141;
2.
deduct any refund received from Ohio form SD 141 ..........................................
3. If line 2 is LESS than line 1, subtract line 2 from line 1 and enter the balance of
school district income tax due ....................................... AMOUNT YOU OWE 
3.
4. If line 2 is GREATER than line 1, subtract line 1 from line 2 and enter the over-
payment of school district income tax ....................................YOUR REFUND 
4.
NOTE: If you do not owe any taxes, write 0.00 in the space on line 3. If you have a balance due, make your check
payable to: School District Income Tax. Complete the reverse side for each school district you withheld for,
the tax liability for each district, and the total payment for each district.
I declare under penalties of perjury that to the best of my knowledge and belief this is a true, correct and complete return.
Signature of responsible person
Title
Telephone number
Address, number and street
City
State
ZIP code
Social Security number of responsible person
Date
For Departmental Use
Mail to:
School District Income Tax
P.O. BOX 182388
Columbus, Ohio 43218-2388

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