Form SD 100 Fillable School District Income Tax Return
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

(Sandusky Seneca) 0100 Logan Shelby) 0100 Pickaway) 0150 Ross) 0125 Seneca) 0050 Union) 0075 Wayne) 0100 Wood) 0125 YOUR REFUND 16 (: 1) Unchecked (: 1) Unchecked (: 1) Unchecked (: 2) Unchecked (: 2) Unchecked (: 2) Unchecked (: 3) Unchecked (: 3) Unchecked (checkbox) Unchecked (continued on next page) (Fairfi eld) 0175 (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) 0502 Athens CSD (Athens) 0100 0908 Ross LSD (Butler) 0075 10 If line 9 is MORE THAN line 6a subtract line 6a from line 9 AMOUNT OVERPAID 10 11 Amount of line 10 to be credited to 2014 school district income tax liability CREDIT TO 2014 11 12 Line 10 minus line 11 Enter here then skip to line 14 12 1204 Northwestern LSD (Clark Champaign) 0100 13 If line 9 is LESS THAN line 6a subtract line 9 from line 6a AMOUNT DUE 13 13020206 14 Interest and penalty due on late paid tax and/or late filed return (see page SD 4 of the instructions) 14 15 Amount due plus interest and penalty (add lines 13 and 14) If payment is enclosed make 16 Refund less interest and penalty (line 12 minus line 14) Enter the amounthere (If line 14 is more than line 12 you have an amount due Subtractline 12 from line 14 and enter this amount on line 15 ) 17 Enter on this line your Ohio taxable income reported on line 5 of Ohio form IT 1040EZ 1704 Crestline EVSD (Crawford Richland) 0025 18 Small business investor income deduction add back (see instructions on page SD 5) 18 19 Total traditional tax base school district income (add lines 17 and 18) If the amount is less 1901 Ansonia LSD (Darke) 0175 1902 Arcanum Butler LSD (Darke) 0150 20 The amount of traditional tax base school district income if any you earned while not 2001 Ayersville LSD (Defi ance) 0100 2004 Hicksville EVSD (Defi ance) 0150 12% 8708 Perrysburg EVSD (Wood) 0050 2% 2013 SD 100 2013 SD 100 pg 2 of 2 21 School district taxable income (line 19 minus line 20; enter 0 if less than zero) Enter 22 Wages and other compensation described on page SD 6 of the instructions 22 23 Net earnings from self employment described on page SD 6 of the instructions If the amount 2301 Amanda Clearcreek LSD (Fairfi eld) 0150 2305 Lancaster CSD (Fairfi eld) 0150 24 Depreciation expense adjustment if any described on page SD 6 of the instructions 24 25 School district taxable income (add lines 22 23 and 24; enter 0 if less than zero) Enter here 2801 Berkshire LSD (Geauga) 0100 2805 Ledgemont LSD (Ashtabula Geauga) 0125 3118 Southwest LSD (Hamilton Butler) 0075 3201 Arcadia LSD (Hancock Seneca) 0100 3202 Arlington LSD (Hancock) 0125 3301 Ada EVSD (Hancock Hardin) 0075 3501 Holgate LSD (Henry) 0150 12% 5507 Piqua CSD (Miami) 0125 14% 3603 Greenfield EVSD (Fayette Highland 3604 Hillsboro CSD (Highland) 0100 1% 2307 Pickerington LSD (Fairfi eld Franklin) 0100 1% 3901 Bellevue CSD (Erie Huron Sandusky 3902 Monroeville LSD (Erie Huron) 0150 3907 Willard CSD (Crawford Huron) 0075 4508 North Fork LSD (Knox Licking) 0100 4901 Jefferson LSD (Madison) 0050 4902 Jonathan Alder LSD (Franklin Madison 5008 Sebring LSD (Mahoning) 0100 5101 Elgin LSD (Delaware Hardin Marion) 0075 5204 Cloverleaf LSD (Medina) 0050 5401 Celina CSD (Mercer) 0075 5501 Bethel LSD (Miami) 0075 5504 Miami East LSD (Champaign Miami) 0175 5505 Milton Union EVSD (Miami) 0125 5509 Troy CSD (Miami) 0150 5902 Highland LSD (Delaware Morrow) 0050 2% 2604 Pettisville LSD (Fulton Henry) 0100 1% 5903 Mount Gilead EVSD (Morrow) 0075 p% 1510 United LSD (Columbiana) 0050 2% 6301 Antwerp LSD (Paulding) 0150 6501 Circleville CSD (Pickaway) 0075 6502 Logan Elm LSD (Hocking Pickaway) 0100 6a Amount from line 6 page 1 6a 7 School district income tax withheld (school district number on W 2(s) W 2G(s) and/or 1099 R(s) 7201 Clyde Green Springs EVSD 7403 Hopewell Loudon LSD (Seneca) 0050 7501 Anna LSD (Shelby) 0125 7502 Botkins LSD (Auglaize Shelby) 0125 7506 Jackson Center LSD (Auglaize 7612 Northwest LSD (Stark Summit 8 Add the 2013 Ohio form SD 100ES payment(s) 2013 Ohio form SD 40P extension payment(s) 8501 Chippewa LSD (Wayne) 0100 8509 Triway LSD (Holmes Wayne) 0075 8702 Eastwood LSD (Wood) 0100 9 Add lines 7 and 8 TOTAL PAYMENTS 9 a resident of the school district whose number you entered above 20 and 2012 school district overpayment credited to 2013 8 and on line 1 of this return 25 at tax ohio gov) AMOUNT DUE PLUS INTEREST AND PENALTY 15 Auglaize Logan) 0100 Berne Union LSD (Fairfi eld Hocking) 0100 1% Bettsville LSD (Seneca) 0100 1% Bexley CSD (Franklin) 0075 p% Big Walnut LSD (Delaware) 0075 p% Bloom Carroll LSD (Fairfi eld) 0125 14% Bluffton EVSD (Allen Hancock) 0050 2% Boldface indicates a newly enacted rate a rate change for 2013 or a change in the tax type Bowling Green CSD (Henry Wood) 0050 2% Bradford EVSD (Darke Miami Shelby) 0175 1p% Bryan CSD (Williams) 0100 1% Buckeye Central LSD (Crawford Huron Buckeye Valley LSD (Delaware Marion Canal Winchester LSD (Fairfield Carey EVSD (Seneca Wyandot) 0100 1% Carlisle LSD (Montgomery Warren) 0100 1% Cedar Cliff LSD (Clark Greene) 0125 14% Centerburg LSD (Delaware Knox Central LSD (Defi ance Williams) 0075 p% check payable to School District Income Tax and include Ohio form SD 40P (see our Web site Clear Fork Valley LSD (Knox Clermont Northeastern LSD (Brown Clermont) 0100 1% Coldwater EVSD (Mercer) 0050 2% Colonel Crawford LSD (Crawford) 0125 14% Columbiana EVSD (Columbiana Columbus Grove LSD (Allen Putnam) 0100 1% Complete this schedule only if filing a traditional tax base school district return Complete this schedule only if filing an earned income only tax base school district return Continental LSD (Putnam) 0100 1% Cory Rawson LSD (Hancock) 0175 1p% Covington EVSD (Miami) 0175 1p% Crestview LSD (Columbiana) 0100 1% Crestview LSD (Van Wert) 0100 1% Dalton LSD (Wayne) 0075 p% Danville LSD (Holmes Knox) 0175 1p% Date (MM/DD/YYYY) Decimal Decimal Decimal Defiance CSD (Defi ance Paulding) 0050 2% Do you authorize your preparer to contact us regarding this return? Earned Income Only Tax Base School Districts Eaton CSD (Preble) 0150 12% Edgerton LSD (Defi ance Williams) 0100 1% Elmwood LSD (Hancock Wood) 0125 14% Evergreen LSD (Fulton Lucas) 0200 2% Fairbanks LSD (Madison Union) 0100 1% Fairborn CSD (Clark Greene Fairfield Union LSD (Fairfi eld Hocking Fairlawn LSD (Shelby) 0075 p% For Department Use Only Fort Loramie LSD (Darke Shelby) 0150 12% Fort Recovery LSD (Darke Mercer) 0150 12% Franklin Monroe LSD (Darke Miami) 0075 p% Franklin) 0075 p% Fremont CSD (Sandusky) 0125 14% Gorham Fayette LSD (Fulton) 0100 1% Goshen LSD (Clermont Warren) 0100 1% Greene) 0100 1% Greeneview LSD (Clinton Fayette Greenville CSD (Darke) 0050 2% Hardin Houston LSD (Shelby) 0075 Hardin Logan) 0050 Hardin Northern LSD (Hancock Hardin) 0175 here and on line 1 of this return 21 Holmes Knox Richland) 0125 If line 9 is MORE THAN line 6a go to line 10 If line 9 is LESS THAN line 6a skip to line 13 If you entered an amount on line 12 skip to line 16 If you entered an amount on line 13 go to line 15 If your refund is $1 00 or less no refund will be issued If you owe $1 00 or less no payment is necessary Income Tax Return is less than 0 type a negative sign ( ) before the figure at right 23 Jennings LSD (Putnam) 0075 Johnstown Monroe LSD (Delaware Kalida LSD (Putnam) 0100 Kenton CSD (Hardin Wyandot) 0150 Lakota LSD (Sandusky Seneca Wood) 0150 Leipsic LSD (Putnam) 0075 Liberty Benton LSD (Hancock) 0075 Liberty Center LSD (Fulton Henry) 0175 Liberty Union Thurston LSD Licking Valley LSD (Licking Muskingum) 0100 Licking) 0050 Licking) 0075 Licking) 0075 p% Licking) 0100 Logan) 0150 London CSD (Madison) 0100 Lorain) 0100 Loudonville Perrysville EVSD (Ashland Madison LSD (Butler) 0050 Madison) 0150 Mahoning) 0100 1% Marion Wyandot) 0125 McComb LSD (Hancock Putnam Mechanicsburg EVSD (Champaign Millcreek West Unity LSD (Williams) 0100 Miller City New Cleveland LSD (Putnam) 0125 Minster LSD (Auglaize Darke Mercer Mississinawa Valley LSD (Darke) 0175 Mohawk LSD (Crawford Seneca Montgomery Preble) 0175 Montgomery) 0050 2% Montpelier EVSD (Williams) 0125 Morrow Union) 0100 1% must agree with school district number in the upper right hand corner on page 1 of this return) 7 National Trail LSD (Darke Preble) 0175 New Bremen LSD (Auglaize Mercer New Knoxville LSD (Auglaize Shelby) 0125 New Lebanon LSD (Montgomery) 0125 New London LSD (Ashland Huron New Miami LSD (Butler) 0100 New Riegel LSD (Seneca) 0150 Newark CSD (Licking) 0100 Newton LSD (Darke Miami) 0175 North Baltimore LSD (Hancock North Union LSD (Delaware Union) 0100 Northmor LSD (Marion Morrow Northwestern LSD (Ashland Wayne) 0125 Norwalk CSD (Huron) 0050 Oberlin CSD (Lorain) 0200 Old Fort LSD (Sandusky Seneca) 0100 or IT 1040 If the amount is less than 0 type a negative sign ( ) before the figure at right 17 Otsego LSD (Henry Lucas Wood) 0100 Ottawa Glandorf LSD (Putnam) 0050 Ottoville LSD (Paulding Putnam) 0075 Pandora Gilboa LSD (Allen Putnam) 0175 Parkway LSD (Auglaize Mercer Patrick Henry LSD (Henry Putnam Paulding EVSD (Paulding Putnam) 0100 Perry) 0200 2% Phone number Phone number (optional) Plymouth Shiloh LSD (Crawford Huron Preble Shawnee LSD (Butler Preparer s printed name (see page SD 3 of the instructions) Rev 11/13 Rev 12/12 Reynoldsburg CSD (Fairfi eld Franklin Richland Seneca) 0150 12% Richland) 0100 Richland) 0100 Ridgemont LSD (Hardin Logan) 0175 Riverdale LSD (Hancock Hardin Riverside LSD (Logan Shelby) 0200 Russia LSD (Darke Shelby) 0075 SCHEDULE A TRADITIONAL TAX BASE SCHOOL DISTRICT AMOUNTS (See page SD 5 of the instructions ) SCHEDULE B EARNED INCOME TAX BASE SCHOOL DISTRICT AMOUNTS (See page SD 6 of the instructions ) School District School District Name (and Counties) Rate Percent School Districts With an Income Tax for 2013 SD 100 SD# School District Name (and Counties) Rate Percent SD# School District Name (and Counties) Rate Percent SD# School District Name (and Counties) Rate Percent See page 1 of this return for mailing information Seneca East LSD (Huron Seneca) 0100 Shelby CSD (Richland) 0100 Shelby) 0100 SIGN HERE (required): I have read this return Under penalties of perjury I declare that to South Central LSD (Huron Richland) 0125 Southeastern LSD (Clark Greene) 0100 Southwest Licking LSD (Fairfield Spencerville LSD (Allen Auglaize Spouse s signature (see page SD 3 of the instructions) Springfield LSD (Mahoning) 0100 Stryker LSD (Williams) 0150 Swanton LSD (Fulton Lucas) 0075 Talawanda CSD (Butler Preble) 0100 Taxable year beginning in Teays Valley LSD (Fairfi eld Franklin than 0 type a negative sign ( ) before the figure at right 19 the best of my knowledge and belief the return and all enclosures are true correct and complete Traditional Tax Base School Districts Traditional Tax Base School Districts (cont d ) Traditional Tax Base School Districts (cont d ) Traditional Tax Base School Districts (cont d ) Tri Village LSD (Darke) 0150 Triad LSD (Champaign Logan Union) 0150 Twin Valley Community LSD (Preble) 0075 Union Scioto LSD (Ross) 0050 Upper Sandusky EVSD (Crawford Upper Scioto Valley LSD (Auglaize Valley View LSD (Montgomery Preble) 0125 Van Wert CSD (Van Wert) 0100 Van Wert) 0100 Van Wert) 0125 Vanlue LSD (Hancock Seneca Versailles EVSD (Darke Shelby) 0100 Walnut Township LSD (Fairfi eld) 0125 Wapakoneta CSD (Auglaize) 0075 Warren) 0050 Wayne Trace LSD (Paulding Putnam Waynesfield Goshen LSD (Allen Wellington EVSD (Huron Lorain) 0100 West Liberty Salem LSD (Champaign Western Reserve LSD (Erie Huron) 0125 Wilmington CSD (Clinton Greene) 0100 Wood) 0150 Wood) 0175 Wyandot) 0100 Wyandot) 0100 Wyoming CSD (Hamilton) 0125 Xenia Community CSD (Greene Yellow Springs EVSD (Clark Greene) 0100 Yes No Your signature