Form Sd 141 Long - School District Employer'S Annual Reconciliation Of Tax Withheld - 2012
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2013 SD 141 Long
Rev. 11/12
School District Employer’s Annual
School District Income Tax
13090100
P.O. Box 182388
Reconciliation of Tax Withheld
Columbus, OH 43218-2388
Go paperless! File your
Ohio withholding acct. no.
FEIN
Payment due date
01/31/2014
return through Ohio
Business Gateway:
tax.ohio.gov
Name
Amended Return
Number and street
Check box if amended return.
City, state, ZIP
Final Return
Check box if out of business
or no more SD employees.
If you do not owe any taxes, write -0- in the space on line 3. If you have a bal-
1. Enter the total amount of
school district income tax re-
ance due, mail one check payable to School District Income Tax for the total
quired to be withheld for ALL
amount. Complete the tax liability and the total payment for each school district
$
active school districts during
for which you withheld tax.
2013.
If this return is an amended SD 141 (i) you must include on the lines below any
2. Enter the amount of pay-
underpayment/overpayment(s) that were on any previously fi led SD 141(s) and
ments made for 2013 on
then add any further adjustments; (ii) add to line 2 total payments made on any
$
Ohio form SD 101 for ALL
previously fi led SD 141(s); and (iii) deduct from line 2 total refund(s) received on
active school districts.
any previously fi led SD 141(s).
DO NOT STAPLE OR OTHERWISE ATTACH YOUR CHECK OR CHECK STUB
3. If line 2 is LESS than line 1,
TO THIS FORM. DO NOT SEND CASH. Make check payable to SCHOOL DIS-
subtract line 2 from line 1 and
enter the balance of school
TRICT INCOME TAX and mail to School District Income Tax, P.O. Box 182388,
district income tax due.
Columbus, OH 43218-2388.
$
AMOUNT YOU OWE
I declare under penalties of perjury that this return, including any accompanying
schedules and statements, has been examined by me and, to the best of my
4. If line 2 is GREATER than
knowledge and belief, is a true, correct and complete return and report.
line 1, subract line 1 from line
2 and enter the overpayment
of school district income tax.
$
Signature
Title
Date
YOUR REFUND
C
D
B
E
A
School District Income
Amount
School
Underpayment/
School District Name
Tax Withheld
of Payment
District No.
(Overpayment)
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