Public School District Of Residence Employee Withholding Certificate
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1PUBLIC SCHOOL DISTRICT OF RESIDENCE EMPLOYEE
WITHHOLDING CERTIFICATE
We are required by Ohio Law (Ohio Revised Code Section 5747.06 (E) ) to ask
employees for their public school district of residence.
Please fill out; sign and date this form. Your district four digit number can be found on
your annual Ohio Income Tax return. Your exemptions are the same for the school
district withholding as they are for state income tax withholding purposes.
Name _________________________ SSN _______________________________
Address___________________________________________________________
Public School District of Residence______________________________________
Public School Number __________________
(
)
I do wish to have school income tax withheld
(
)
I do not wish to have school income tax withheld
Signature ____________________________ Date __________________________
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