IT 4 Rev. 5/07 Notice to Employee 1. For state purposes, an individual may claim only natural de- For further information, consult the Ohio Department of Taxa- pendency exemptions. This includes the taxpayer, spouse tion, Personal and School District Income Tax Division, or and each dependent. Dependents are the same as defined your employer. in the Internal Revenue Code and as claimed in the taxpayer’s federal income tax return for the taxable year for which the 3. If you expect to owe more Ohio income tax than will be taxpayer would have been permitted to claim had the tax- withheld, you may claim a smaller number of exemptions; payer filed such a return. or under an agreement with your employer, you may have an additional amount withheld each pay period. 2. You may file a new certificate at any time if the number of your exemptions increases. 4. A married couple with both spouses working and filing a joint return will, in many cases, be required to file an indi- You must file a new certificate within 10 days if the number of vidual estimated income tax form IT 1040ES even though exemptions previously claimed by you decreases because: Ohio income tax is being withheld from their wages. This (a) Your spouse for whom you have been claiming exemp- result may occur because the tax on their combined in- tion is divorced or legally separated, or claims her (or his) come will be greater than the sum of the taxes withheld own exemption on a separate certificate. from the husband’s wages and the wife’s wages. This (b) The support of a dependent for whom you claimed ex- requirement to file an individual estimated income tax form emption is taken over by someone else. IT 1040ES may also apply to an individual who has two (c) You find that a dependent for whom you claimed exemp- jobs, both of which are subject to withholding. In lieu of tion must be dropped for federal purposes. filing the individual estimated income tax form IT 1040ES, the individual may provide for additional withholding with The death of a spouse or a dependent does not affect your his employer by using line 5. withholding until the next year but requires the filing of a new certificate. If possible, file a new certificate by Dec. 1st of the year in which the death occurs. ✁ please detach here IT 4 Department of Rev. 5/07 hio Taxation Employee’s Withholding Exemption Certificate Print full name Social Security number Home address and ZIP code Public school district of residence School district no. (See The Finder at tax.ohio.gov.) 1. Personal exemption for yourself, enter “1” if claimed ............................................................................................................... 2. If married, personal exemption for your spouse if not separately claimed (enter “1” if claimed) ............................................ 3. Exemptions for dependents ....................................................................................................................................................... 4. Add the exemptions that you have claimed above and enter total ........................................................................................... 5. Additional withholding per pay period under agreement with employer .................................................................................. $ Under the penalties of perjury, I certify that the number of exemptions claimed on this certificate does not exceed the number to which I am entitled. Signature Date Ohio Public School District Numbers Below is a list of the identifi cation numbers of all public school dis- An asterisk (*) and bold print indicate a school district with Personal Income Tax tricts in Ohio. Enter on the front of Ohio form IT 1040EZ or IT 1040 an income tax in effect for 2012. If you lived in (resided) or were the number of the school district where you lived (resided) or where domiciled in one of these school districts for all or part of the year, you were domiciled for the majority of 2012. Each district is listed you are required to fi le a school district income tax return, Ohio under the county or counties in which the school district is located. form SD 100. Do not use nonpublic or joint vocational school districts. Full-year non-Ohio domiciliaries should use 9999. If you do not know the public school district in which you live, see The Finder on page 42. ADAMS COUNTY * Spencerville LSD ................................... 0209 CHAMPAIGN COUNTY Adams County/Ohio Valley LSD ..............0101 St. Marys CSD .........................................0604 Graham LSD............................................ 1101 Bright LSD ...............................................3601 * Upper Scioto Valley LSD .......................3306 * Mechanicsburg EVSD ........................... 1102 Eastern LSD ............................................0801 * Wapakoneta CSD ................................... 0605 * Miami East LSD...................................... 5504 Manchester LSD ......................................0102 * Waynesfi eld-Goshen LSD .....................0606 Northeastern LSD ....................................1203 * Northwestern LSD ................................. 1204 ALLEN COUNTY BELMONT COUNTY * Triad LSD ................................................ 1103 Allen East LSD ........................................ 0201 Barnesville EVSD ....................................0701 Urbana CSD ............................................1104 Bath LSD .................................................0202 Bellaire CSD ............................................0702 * West Liberty-Salem LSD .......................1105 * Bluffton EVSD ........................................ 0203 Bridgeport EVSD .....................................0703 * Columbus Grove LSD ........................... 6901 Buckeye LSD ...........................................4101 CLARK COUNTY Delphos CSD ...........................................0204 Harrison Hills CSD................................... 3402 * Cedar Cliff LSD ......................................2902 Elida LSD................................................. 0205 Martins Ferry CSD ...................................0704 Clark-Shawnee LSD ................................1207 Lima CSD ................................................0206 Shadyside LSD ........................................0705 * Fairborn CSD ......................................... 2903 * Pandora-Gilboa LSD.............................. 6909 St. Clairsville-Richland CSD ....................0706 Greenon LSD........................................... 1201 Perry LSD ................................................0207 Switzerland of Ohio LSD ......................... 5601 Northeastern LSD ....................................1203 Shawnee LSD.......................................... 0208 Union LSD ...............................................0707 * Northwestern LSD ................................. 1204 * Spencerville LSD ................................... 0209 * Southeastern LSD ................................. 1205 * Waynesfi eld-Goshen LSD .....................0606 BROWN COUNTY Springfi eld CSD .......................................1206 Bethel-Tate LSD ......................................1302 Tecumseh LSD ........................................1202 ASHLAND COUNTY Blanchester LSD...................................... 1401 * Yellow Springs EVSD ............................2907 Ashland CSD ...........................................0301 * Clermont-Northeastern LSD ................. 1303 Black River LSD ...................................... 5201 Eastern LSD ............................................0801 CLERMONT COUNTY Crestview LSD .........................................7002 Fayetteville-Perry LSD............................. 0802 Batavia LSD............................................. 1301 Hillsdale LSD ...........................................0302 Georgetown EVSD ..................................0803 Bethel-Tate LSD ......................................1302 * Loudonville-Perrysville EVSD .............. 0303 Lynchburg-Clay LSD ...............................3605 Blanchester LSD...................................... 1401 Lucas LSD ...............................................7004 Ripley Union Lewis Huntington LSD........ 0804 * Clermont-Northeastern LSD ................. 1303 Mapleton LSD ..........................................0304 Western Brown LSD ................................0805 Felicity-Franklin LSD ...............................1304 * New London LSD ...................................3903 Williamsburg LSD ....................................1309 Forest Hills LSD....................................... 3104 * Northwestern LSD ................................. 8505 * Goshen LSD ........................................... 1305 West Holmes LSD ...................................3802 BUTLER COUNTY Little Miami LSD ...................................... 8306 College Corner LSD ................................ 6801 Loveland CSD .........................................3108 ASHTABULA COUNTY Edgewood CSD .......................................0901 Milford EVSD ...........................................1306 Ashtabula Area CSD................................ 0401 Fairfi eld CSD ........................................... 0902 New Richmond EVSD ............................. 1307 Buckeye LSD ...........................................0402 Hamilton CSD ..........................................0903 West Clermont LSD .................................1308