Declaration Control Number (DCN)

00– – – 1 IRS Use Only—Do not write or staple in this space.

U.S. Individual Income Tax Declaration

Form 8453 for an IRS e-file Return
OMB No. 1545-0936

Department of the Treasury

Internal Revenue Service
For the year January 1–December 31, 2000
䊳 See instructions on back.
2000
Your first name and initial Last name Your social security number
L
Use the A
B If a joint return, spouse’s first name and initial Last name Spouse’s social security number
IRS label. E
Otherwise, L
please
print or H
Home address (number and street). If you have a P.O. box, see instructions. Apt. no.
䊱 Important! 䊱
E You must enter
type. R
E City, town or post office, state, and ZIP code your SSN(s) above.
Daytime phone number
( )
Part I Tax Return Information (Whole dollars only)
1 Adjusted gross income (Form 1040, line 33; Form 1040A, line 19; Form 1040EZ, line 4) 1
2 Total tax (Form 1040, line 57; Form 1040A, line 35; Form 1040EZ, line 10) 2
3 Federal income tax withheld (Form 1040, line 58; Form 1040A, line 36; Form 1040EZ, line 7) 3
4 Refund (Form 1040, line 67a; Form 1040A, line 42a; Form 1040EZ, line 11a) 4
5 Amount you owe (Form 1040, line 69; Form 1040A, line 44; Form 1040EZ, line 12) 5
Part II Declaration of Taxpayer (Sign only after Part I is completed.)

6a I consent that my refund be directly deposited as designated in the electronic portion of my 2000 Federal income tax return. If I have filed a joint
return, this is an irrevocable appointment of the other spouse as an agent to receive the refund.
b I do not want direct deposit of my refund or I am not receiving a refund.
c I authorize the U.S. Treasury and its designated Financial Agent to initiate an ACH debit (electronic withdrawal) entry to the financial institution
account indicated in the tax preparation software for payment of my Federal taxes owed on this return and/or a payment of estimated tax. I further
understand that this authorization may apply to subsequent Federal tax payments that I direct to be debited through the Electronic Federal Tax
Payment System (EFTPS). In order for me to initiate subsequent payments, I request that the IRS send me a personal identification number (PIN)
to access EFTPS. This authorization is to remain in full force and effect until I notify the U.S. Treasury Financial Agent to terminate the authorization.
To revoke a payment, I must contact the U.S. Treasury Financial Agent at 1-888-353-4537 no later than 2 business days prior to the payment
(settlement) date. I also authorize the financial institutions involved in the processing of the electronic payment of taxes to receive confidential
information necessary to answer inquiries and resolve issues related to the payment.
If I have filed a balance due return, I understand that if the IRS does not receive full and timely payment of my tax liability, I will remain liable for the tax
liability and all applicable interest and penalties. If I have filed a joint Federal and state tax return and there is an error on my state return,
I understand my Federal return will be rejected.
Under penalties of perjury, I declare that the information I have given my ERO and the amounts in Part I above agree with the amounts on the corresponding
lines of the electronic portion of my 2000 Federal income tax return. To the best of my knowledge and belief, my return is true, correct, and complete. I
consent to my ERO sending my return, this declaration, and accompanying schedules and statements to the IRS. I also consent to the IRS sending my ERO
and/or transmitter an acknowledgment of receipt of transmission and an indication of whether or not my return is accepted, and, if rejected, the reason(s)
for the rejection, and, if I am applying for a refund anticipation loan or similar product, an indication of a refund offset. If the processing of my return or refund
is delayed, I authorize the IRS to disclose to my ERO and/or transmitter the reason(s) for the delay, or when the refund was sent.

Sign
Here 䊳 Your signature Date 䊳 Spouse’s signature. If a joint return, both must sign. Date

Part III Declaration of Electronic Return Originator (ERO) and Paid Preparer (See instructions.)
I declare that I have reviewed the above taxpayer’s return and that the entries on Form 8453 are complete and correct to the best of my knowledge. If I am
only a collector, I am not responsible for reviewing the return and only declare that this form accurately reflects the data on the return. The taxpayer will
have signed this form before I submit the return. I will give the taxpayer a copy of all forms and information to be filed with the IRS, and have followed all
other requirements in Pub. 1345, Handbook for Authorized IRS e-file Providers of Individual Income Tax Returns. If I am also the Paid Preparer, under
penalties of perjury I declare that I have examined the above taxpayer’s return and accompanying schedules and statements, and to the best of my knowledge
and belief, they are true, correct, and complete. This Paid Preparer declaration is based on all information of which I have any knowledge.

䊳
Date Check if Check ERO’s SSN or PTIN
ERO’s also paid if self-
ERO’s signature preparer employed
Use
Only
Firm’s name (or
yours if self-employed),
address, and ZIP code
䊳 EIN
Phone no. ( )
Under penalties of perjury, I declare that I have examined the above taxpayer’s return and accompanying schedules and statements, and to the best of my
knowledge and belief, they are true, correct, and complete. This declaration is based on all information of which I have any knowledge.

䊳
Date Check Preparer’s SSN or PTIN
Preparer’s if self-
Paid signature employed

䊳
Preparer’s Firm’s name (or EIN
yours if self-employed),
Use Only address, and ZIP code Phone no. ( )

For Paperwork Reduction Act Notice, see back of form. Cat. No. 62766T Form 8453 (2000)
Form 8453 (2000) Page 2

General Instructions label, print or type the information in the 2. The total tax on line 2, the Federal
spaces provided. income tax withheld on line 3, the refund
A Change To Note P.O. Box. Enter the box number only if on line 4, or the amount owed on line 5
the post office does not deliver mail to differs from the amount on the electronic
Beginning in 2000, you may use Form
the taxpayer’s home. return by more than $14.
8453 to authorize a direct debit entry for
a payment of estimated tax. Note: The address must match the Part III—Declaration of Electronic
address shown on the electronically filed Return Originator (ERO) and Paid
Purpose of Form retur n. Preparer
Use Form 8453 to: Social Security Number (SSN). Be sure The IRS requires the ERO’s signature. A
● Authenticate the electronic portion of to enter the taxpayer’s SSN in the space paid preparer must sign Form 8453 in
Form 1040, 1040A, or 1040EZ, provided on Form 8453. If a joint return, the space for Paid Preparer’s Use Only.
● Send any accompanying paper list the SSNs in the same order as the Only handwritten signatures are
schedules or statements, first names. acceptable. But if the paid preparer is
● Authorize the electronic return Part I—Tax Return Information also the ERO, do not complete the paid
originator (ERO) to transmit via a preparer’s section. Instead, check the
Line 5. Do not include any payment with box labeled “Check if also paid
third-party transmitter, and Form 8453. The method of payment preparer.”
● Provide the taxpayer’s consent to depends on whether the taxpayer
directly deposit any refund and/or Note: If the paid preparer’s signature
checks the box on line 6b or 6c. For
authorize a direct debit entry for cannot be obtained on Form 8453, you
details, see the instructions for Part II.
payment of Federal taxes owed and/or a may attach a copy of Form 1040,
payment of estimated tax. Part II—Declaration of Taxpayer 1040A, or 1040EZ instead. Attach only
pages 1 and 2, and write “COPY—DO
Note: All taxpayers must check all NOT PROCESS” on each page.
When and Where To File applicable boxes on lines 6a, 6b, and/or
This form must be mailed to the service 6c. Refunds. After the IRS has accepted the
center where the electronic return was return, the refund should be issued
If there is an amount on line 5 and the within 3 weeks. However, some refunds
transmitted within 3 business days after taxpayer checks the box on line 6b and
the ERO has received acknowledgment may be delayed because of compliance
is paying by check or money order, mail reviews to ensure that returns are
from the IRS that the return was the payment by April 16, 2001, with
accepted. See Pub. 1345A, Filing accurate.
Form 1040-V to the applicable address
Season Supplement for Authorized IRS shown on that form. Refund Information. Refund information
e-file Providers, for the address. Only is available on TeleTax. Call
If the taxpayer checks the box on line 1-800-829-4477.
the Andover, Austin, Cincinnati,
6c, the taxpayer must ensure that the
Memphis, and Ogden Service Centers
following information relating to the
can accept electronic returns. Paperwork Reduction Act Notice. We
financial institution account is provided
in the tax preparation software. ask for the information on this form to
Line Instructions carry out the Internal Revenue laws of
Declaration Control Number (DCN). ● Routing number. the United States. You are required to
The DCN is a 14-digit number assigned ● Account number. give us the information. We need it to
by the ERO to each return. Clearly type ● Type of account (checking or savings). ensure that you are complying with
or print the DCN in the top left corner of these laws and to allow us to figure and
● Debit amount.
each Form 8453. Enter the number after collect the right amount of tax.
the IRS has acknowledged receipt of the ● Debit date (date the taxpayer wants
You are not required to provide the
electronic return as follows: the debit to occur).
information requested on a form that is
An electronically transmitted return will subject to the Paperwork Reduction Act
Boxes Entry
not be considered complete, and unless the form displays a valid OMB
1–2 File identification number therefore filed, unless and until a Form control number. Books or records
(always “00”) 8453 signed by the taxpayer is received relating to a form or its instructions must
by the IRS. be retained as long as their contents
3–8 Electronic filer identification may become material in the
number (EFIN) assigned by The taxpayer’s signature allows the
IRS to disclose to the ERO and/or administration of any Internal Revenue
the IRS law. Generally, tax returns and return
transmitter the reason(s) for a delay in
9–11 Batch number (000 to 999) processing the return or refund. In the information are confidential, as required
assigned by the ERO case of a taxpayer who is applying for a by Internal Revenue Code section 6103.
12–13 Serial number (00 to 99) refund anticipation loan or similar The time needed to complete and file
assigned by the ERO product, the taxpayer’s signature also this form will vary depending on
14 Year digit (for returns filed in allows the IRS to advise the ERO and/or individual circumstances. The estimated
2001, the year digit is “1”) transmitter if a refund offset may occur. average time is 15 minutes. If you have
If the ERO makes changes to the comments concerning the accuracy of
Example. The EFIN is 509325. The
electronic return after Form 8453 has this time estimate or suggestions for
batch number is 000. The serial number
been signed by the taxpayer but before making this form simpler, we would be
is 56. The DCN is 00-509325-00056-1.
it is transmitted and either 1 or 2 below happy to hear from you. You can write
Name and Address. If the taxpayer applies, the ERO must have the to the Tax Forms Committee, Western
received a peel-off name and address taxpayer complete and sign a corrected Area Distribution Center, Rancho
label from the IRS, put the label in the Form 8453. Cordova, CA 95743-0001. Do not send
name area. Cross out any errors and the form to this address. Instead, see
print the correct information. Add any 1. The adjusted gross income on line 1
differs from the amount on the electronic When and Where To File on this page.
missing items, such as apartment
number. If the taxpayer did not receive a return by more than $50 or