Form SD 141 Fillable School District Employer's Annual Reconciliation
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

(checkbox) Unchecked (Overpayment) (Reset Form) Reset Form (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) 13090100 13090200 2 and enter the overpayment 2013 SD 141 Long 4 If line 2 is GREATER than active school districts active school districts during Amended Return Amount amount Complete the tax liability and the total payment for each school district AMOUNT YOU OWE any previously filed SD 141(s) Business Gateway: Check box if amended return Check box if out of business City state ZIP Columbus OH 43218 2388 district income tax due District No DO NOT STAPLE OR OTHERWISE ATTACH YOUR CHECK OR CHECK STUB due mail one check payable to School District Income Tax for the total Enter the amount of payments enter the balance of school Enter the total amount of Final Return For the Period Ending for which you withheld tax Go paperless! File your I declare under penalties of perjury that this return including any accompanying If line 2 is LESS than line 1 If this return is an amended SD 141 (i) you must include on the lines below any If you do not owe any taxes write 0 in the space on line 3 If you have a balance knowledge and belief is a true correct and complete return and report line 1 subract line 1 from line made for 2013 on Number and street of Payment of school district income tax Ohio form SD 101 for ALL Ohio Withholding Account No Ohio withholding acct no or no more SD employees P O Box 182388 Payment due date01/31/2014 previously filed SD 141(s); and (iii) deduct from line 2 total refund(s) received on Reconciliation of Tax Withheld return through Ohio Rev 11/12 schedules and statements has been examined by me and to the best of my School School District Employer s Annual School District Income school district income tax required School District Income Tax School District Income Tax School District Name SD 141 LongRev 11/12Page 2 Signature subtract line 2 from line 1 and tax ohio gov Tax Withheld then add any further adjustments; (ii) add to line 2 total payments made on any Title Date to be withheld for ALL TO THIS FORM DO NOT SEND CASH Make check payable to SCHOOL DIS TRICT INCOME TAX and mail to School District Income Tax P O Box 182388 Underpayment/ underpayment/overpayment(s) that were on any previously filed SD 141(s) and YOUR REFUND