Common use of Federal Privacy Act Notice Clause in Contracts

Federal Privacy Act Notice. Because we require you to provide us with a Social Security number, the Federal Privacy Act of 1974 requires us to inform you that providing us with your Social Security number is mandatory. Ohio Revised Code sections 5703.05, 5703.057 and 5747.08 authorize us to request this information. We need your Social Security number in order to administer this tax. School District Income Tax Payment Voucher • Do NOT staple or paper clip. • Do NOT send cash. OHIO SD 40P Rev. 7/17 2017SP School district number Do NOT fold check or voucher. Use UPPERCASE letters to print the first three letters of Taxpayer’s last name Spouse’s last name (only if joint filing) Taxpayer’s SSN Spouse’s SSN (only if joint filing) • Include this voucher with your payment for your original 2017 school district income tax return. • Make payment payable to: School District Income Tax • Mail to: School District Income Tax, X.X. Xxx 000000, Xxxxxxxx, XX 00000-0000 Amount of Payment $   First name M.I. Last name Spouse’s first name (only if joint filing) M.I. Last name Address City, state, ZIP code  Cut on the dotted lines. Use only black ink. , , 0 0 508 Do not staple or paper clip. Rev. 8/18 2018 Ohio IT 1040 Individual Income Tax Return Use only black ink and UPPERCASE letters. 18000102 Sequence No. 1 Check here if this is an amended return. Include the Ohio IT RE (do NOT include a copy of the previously filed return). Check here if this is a Net Operating Loss (NOL) carryback. Include Ohio Schedule IT NOL. Taxpayer's SSN (required)  If deceased check box Spouse’s SSN (if filing jointly)  If deceased check box Enter school district # for this return (see instructions). SD# First name Spouse's first name (only if married filing jointly) Address line 1 (number and street) or P.O. Box X.X. X.X. Last name Last name Address line 2 (apartment number, suite number, etc.) City State ZIP code Ohio county (first four letters) Foreign country (if the mailing address is outside the U.S.) Foreign postal code 

Federal Privacy Act Notice. Because we require you to provide us with a Social Security number, the Federal Privacy Act of 1974 requires us to inform you that providing us with your Social Security number is mandatory. Ohio Revised Code sections 5703.05, 5703.057 and 5747.08 authorize us to request this information. We need your Social Security number in order to administer this tax. School District Income Tax Payment Voucher  Cut on the dotted lines. Use only black ink. OHIO IT 40P Rev. 7/17 • Do NOT staple or paper clip. • Do NOT send cash. OHIO SD 40P Rev. 7/17 2017SP School district number Taxable Year Do NOT fold check or voucher. Income Tax Payment Voucher • Do NOT send cash. 2017   Use UPPERCASE letters to print the first three letters of Taxpayer’s Spouse’s last name Spouse’s last name (only if joint filing) Taxpayer’s SSN Spouse’s SSN (only if joint filing) • Include this voucher with your payment for your original 2017 school district income tax return. • Make payment payable to: School District Income Tax • Mail to: School District Income Tax, X.X. Xxx 000000, Xxxxxxxx, XX 00000-0000 Amount of Payment $   First name M.I. Last name Spouse’s first name (only if joint filing) M.I. Last name Address City, state, ZIP code  Cut on the dotted linesTaxpayer’s SSN Spouse’s SSN (only if joint filing) • Include this voucher with your payment for your original 2017 Ohio income tax return. Use only black ink. Amount of $ , , . 0 0 508 • Make payment payable to: Ohio Treasurer of State • Sending with return - Mail to: Ohio Department of Taxation, X.X. Xxx 0000, Xxxxxxxx, XX 00000-0000 • Sending without return - Mail to: Ohio Department of Taxation, X.X. Xxx 000000, Xxxxxxxx, XX 00000-0000 Payment 402 Do not staple or paper clip. 2017 Ohio SD 100 Rev. 8/18 2018 Ohio IT 1040 Individual 9/17 School District Income Tax Return Use only black ink and UPPERCASE letters. 18000102 Sequence NoFile a separate Ohio SD 100 for each taxing school district in which you lived during the taxable year. 1 17020102 Check here if this is an amended return. Include the Ohio IT SD RE (do NOT include a copy of the previously filed return). Check here if this is a Net Operating Loss (NOL) carryback. Include Ohio Schedule IT NOL. Taxpayer's ’s SSN (required)   If deceased check box Spouse’s SSN (if filing jointly)   If deceased check box Enter school district # for this return (see instructions). SD# check box check box SD# First name M.I. Last name Spouse's first name (only if married filing jointly) M.I. Last name Address line 1 (number and street) or P.O. Box X.X. X.X. Last name Last name Address line 2 (apartment number, suite number, etc.) City State ZIP code Ohio county (first four letters) Foreign country (if the mailing address is outside the U.S.) Foreign postal code School District Residency – Check applicable box Full-year Part-year resident Full-year nonresident resident of SD# above of SD# above Enter date / / / /of nonresidency to Check applicable box for spouse (only if married filing jointly) Full-year Part-year resident Full-year nonresident resident of SD# above of SD# above Enter date / / / / of nonresidency to Filing Status – Check one (must match the Ohio IT 1040): Single, head of household or qualifying widow(er) Married filing jointly Married filing separately Tax Type – Check one (for an explanation, see instructions) The school district for which this return is being filed is a(n): Traditional tax base school district. You must start with Schedule A, line 19, on page 2 of this return. Earned income tax base school district. You must start with Schedule B, line 24, on page 2 of this return. Do not staple or paper clip. . 0 0 . 0 0 . 0 0 . 0 0 . 0 0 . 0 0

Federal Privacy Act Notice. Because we require you to provide us with a Social Security number, the Federal Privacy Act of 1974 requires us to inform you that providing us with your Social Security number is mandatory. Ohio Revised Code sections 5703.05, 5703.057 and 5747.08 authorize us to request this information. We need your Social Security number in order to administer this tax. School District Income Tax Payment Voucher  Cut on the dotted lines. Use only black ink. OHIO IT 40P Rev. 7/17 • Do NOT staple or paper clip. • Do NOT send cash. OHIO SD 40P Rev. 7/17 2017SP School district number Taxable Year Do NOT fold check or voucher. Income Tax Payment Voucher • Do NOT send cash. 2017   Use UPPERCASE letters to print the first three letters of Taxpayer’s Spouse’s last name Spouse’s last name (only if joint filing) Taxpayer’s SSN Spouse’s SSN (only if joint filing) • Include this voucher with your payment for your original 2017 school district income tax return. • Make payment payable to: School District Income Tax • Mail to: School District Income Tax, X.X. Xxx 000000, Xxxxxxxx, XX 00000-0000 Amount of Payment $   First name M.I. Last name Spouse’s first name (only if joint filing) M.I. Last name Address City, state, ZIP code  Cut on the dotted linesTaxpayer’s SSN Spouse’s SSN (only if joint filing) • Include this voucher with your payment for your original 2017 Ohio income tax return. Use only black ink. Amount of $ , , . 0 0 508 • Make payment payable to: Ohio Treasurer of State • Sending with return - Mail to: Ohio Department of Taxation, X.X. Xxx 0000, Xxxxxxxx, XX 00000-0000 • Sending without return - Mail to: Ohio Department of Taxation, X.X. Xxx 000000, Xxxxxxxx, XX 00000-0000 Payment 402 Do not staple or paper clip. 2017 Ohio SD 100 Rev. 8/18 2018 Ohio IT 1040 Individual 9/17 School District Income Tax Return Use only black ink and UPPERCASE letters. 18000102 Sequence NoFile a separate Ohio SD 100 for each taxing school district in which you lived during the taxable year. 1 17020102 Check here if this is an amended return. Include the Ohio IT SD RE (do NOT include a copy of the previously filed return). Check here if this is a Net Operating Loss (NOL) carryback. Include Ohio Schedule IT NOL. Taxpayer's ’s SSN (required)   If deceased check box Spouse’s SSN (if filing jointly)   If deceased check box Enter school district # for for‌ this return (see instructions). SD# check box check box SD# First name M.I. Last name Spouse's first name (only if married filing jointly) M.I. Last name Address line 1 (number and street) or P.O. Box X.X. X.X. Last name Last name Address line 2 (apartment number, suite number, etc.) City State ZIP code Ohio county (first four letters) Foreign country (if the mailing address is outside the U.S.) Foreign postal code School District Residency – Check applicable box Full-year Part-year resident Full-year nonresident resident of SD# above of SD# above Enter date / / / /of nonresidency to Check applicable box for spouse (only if married filing jointly) Full-year Part-year resident Full-year nonresident resident of SD# above of SD# above Enter date / / / / of nonresidency to Filing Status – Check one (must match the Ohio IT 1040): Single, head of household or qualifying widow(er) Married filing jointly Married filing separately Tax Type – Check one (for an explanation, see instructions) The school district for which this return is being filed is a(n): Traditional tax base school district. You must start with Schedule A, line 19, on page 2 of this return. Earned income tax base school district. You must start with Schedule B, line 24, on page 2 of this return. Do not staple or paper clip. . 0 0 . 0 0 . 0 0 . 0 0 . 0 0 . 0 0

Federal Privacy Act Notice. Because we require you to provide us with a Social Security number, the Federal Privacy Act of 1974 requires us to inform you that providing us with your Social Security number is mandatory. Ohio Revised Code sections 5703.05, 5703.057 and 5747.08 authorize us to request this information. We need your Social Security number in order to administer this tax. School District Income Tax Payment Voucher  Cut on the dotted lines. Use only black ink. OHIO IT 40P Rev. 7/17 • Do NOT staple or paper clip. • Do NOT send cash. OHIO SD 40P Rev. 7/17 2017SP School district number Taxable Year Do NOT fold check or voucher. Income Tax Payment Voucher • Do NOT send cash. 2017   Use UPPERCASE letters to print the first three letters of Taxpayer’s Spouse’s last name Spouse’s last name (only if joint filing) Taxpayer’s SSN Spouse’s SSN (only if joint filing) • Include this voucher with your payment for your original 2017 school district income tax return. • Make payment payable to: School District Income Tax • Mail to: School District Income Tax, X.X. Xxx 000000, Xxxxxxxx, XX 00000-0000 Amount of Payment $   First name M.I. Last name Spouse’s first name (only if joint filing) M.I. Last name Address City, state, ZIP code  Cut on the dotted linesTaxpayer’s SSN Spouse’s SSN (only if joint filing) • Include this voucher with your payment for your original 2017 Ohio income tax return. Use only black ink. Amount of $ , , . 0 0 508 • Make payment payable to: Ohio Treasurer of State • Sending with return - Mail to: Ohio Department of Taxation, X.X. Xxx 0000, Xxxxxxxx, XX 00000-0000 • Sending without return - Mail to: Ohio Department of Taxation, X.X. Xxx 000000, Xxxxxxxx, XX 00000-0000 Payment 402 Do not staple or paper clip. Rev. 8/18 2018 Ohio IT 1040 Individual Income Tax Return Use only black ink and UPPERCASE letters. 18000102 Sequence No. 1 Check here if this is an amended return. Include the Ohio IT RE (do NOT include a copy of the previously filed return). Check here if this is a Net Operating Loss (NOL) carryback. Include Ohio Schedule IT NOL. Taxpayer's SSN (required)  If deceased check box Spouse’s SSN (if filing jointly)  If deceased check box Enter school district # for this return (see instructions). SD# First name Spouse's first name (only if married filing jointly) Address line 1 (number and street) or P.O. Box X.X. X.X. Last name Last name Address line 2 (apartment number, suite number, etc.) City State ZIP code Ohio county (first four letters) Foreign country (if the mailing address is outside the U.S.) Foreign postal code 