
Ada EVSD 3301
Amanda-Clearcreek LSD 2301
Anna LSD 7501
Ansonia LSD 1901
Antwerp LSD 6301
Arcadia LSD 3201
Arcanum-Butler LSD 1902
Arlington LSD 3202
Athens CSD
0502
Ayersville LSD 2001
Bellevue CSD 3901
Berkshire LSD 2801
Berne-Union LSD 2302
Bethel LSD 5501
Bexley CSD 2501
Big Walnut LSD 2101
Bloom-Carroll LSD 2303
Bluffton EVSD 0203
Botkins LSD 7502
Bowling Green CSD 8701
Bradford EVSD 5502
Bryan CSD 8601
Buckeye Central LSD 1701
Buckeye Valley LSD 2102
Canal Winchester LSD 2502
Cardington-Lincoln LSD 5901
Carey EVSD 8801
Carlisle LSD 8301
Cedar Cliff LSD 2902
Celina CSD 5401
Centerburg LSD 4201
Central LSD 2002
Chippewa LSD 8501
Circleville CSD 6501
Clear Fork Valley LSD 7001
Clermont-Northeastern LSD 1303
Cloverleaf LSD 5204
Clyde-Green Springs EVSD 7201
Coldwater EVSD 5402
Colonel Crawford LSD 1703
Columbiana EVSD 1502
Columbus Grove LSD 6901
Continental LSD 6902
Cory-Rawson LSD 3203
Covington EVSD 5503
Crestline EVSD 1704
Crestview LSD 1503
Crestview LSD 8101
Dalton LSD 8502
Danville LSD 4202
Defi ance CSD 2003
Eastwood LSD 8702
Eaton CSD 6803
Edgerton LSD 8602
Edon Northwest LSD 8603
Elgin LSD 5101
Elmwood LSD 8703
Evergreen LSD 2602
Fairbanks LSD 8001
Fairborn CSD 2903
Fairfi eld Union LSD 2304
Fairlawn LSD 7503
Fort Loramie LSD 7504
Fort Recovery LSD 5406
Franklin Monroe LSD 1903
Fremont CSD 7202
Gibsonburg EVSD 7203
Gorham Fayette LSD 2603
Goshen LSD 1305
Greeneview LSD 2904
Greenfi eld EVSD 3603
Greenville CSD 1904
Hardin-Houston LSD 7505
Hardin Northern LSD 3302
Hicksville EVSD 2004
Highland LSD 5902
Hillsboro CSD 3604
Hillsdale LSD 0302
Holgate LSD 3501
Hopewell-Loudon LSD 7403
Jackson Center LSD 7506
Ohio withholding acct. no. FEIN Payment due date For the period ending
Name
Number and street
City, state, ZIP
Total tax due
DO NOT STAPLE OR OTHERWISE ATTACH YOUR CHECK
OR CHECK STUB TO THIS FORM. DO NOT SEND CASH.
Make check payable to SCHOOL DISTRICT INCOME TAX and
mail to School District Income Tax, P.O. Box 182388, Columbus,
OH 43218-2388.
2016 SD 101 Long
Employer’s Payment of School
District Income Tax Withheld
Rev. 12/15
District
Tax Due
District
Number
District Name
District
Number
District Name
District
Tax Due
Signature Title Date
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 knowledge and belief, is a true,
correct and complete return and report.
For State Use Only
MDDYMY
Go paperless! File your return through Ohio
Business Gateway: tax.ohio.gov
School District Income Tax
P.O. Box 182388
Columbus, OH 43218-2388
16070100