rom 8453-F

Department of the Treasury
Internal Revenue Service

U.S. Fiduciary Income Tax Declaration and Signature
for Electronic/Magnetic Media Filing

For calendar year 1991, or fiscal year beginning ...-

OMB No. 1545-0967

a 1991

--- , 1991, and ending ...-

Name of estate or trust

Employer identification number

Name and title of fiduciary

Tax Return Information

1 Total income (Form 1041, line 9). 1
2 Income distribution deduction (Form 1041, line 18) we 2
3 Taxable income of fiduciary (Form 1041, line 22) 3
4 Total tax (Form 1041, line 23). “4
5 Tax Due or Overpayment (Form 1041, line 27 or 28) . 5
Under penalties of perjury, | declare that the above amounts (or the amounts on the attached listing) agree with the amounts shown on the corresponding
lines of the 1991 U.S. Fiduciary Income Tax Return(s). | have also examined a copy of the return(s) being filed via electronic/magnetic media with the
Internal Revenue Service, and all accompanying schedules and statements. To the best of my knowledge and belief, they are true, correct, and complete.
Pl Deciaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. If |am not the transmitter, | have consented
TEASE | that the return(s), including this declaration and accompanying schedules and statements, be sent to the Internal Revenue Service by the return transmitter.
Sign
Here
» Signature of fiduciary or officer representing fiduciary » Date
Date Preparer’s social security number
Paid | Preparer’s > Check it .
Preparer’s | signature self-employed > ["] H
Use Onh Firm’s name (or >
y yours if self-employed) EJ. No.
and address ZIP code >

Paperwork Reduction Act Notice.—We ask for the
information on this form to carry out the Internal Revenue
laws of the United States. You are required to give us the
information. We need it to ensure that you are complying
with these laws and to allow us to figure and collect the right
amount of tax.

The time needed to complete and file this form will vary
depending on individual circumstances. The estimated
average time is: Recordkeeping, 7 minutes; Learning about
the law or the form, 1 minute; Preparing the form, 13
minutes; Copying, assembling, and sending the form to
the IRS, 20 minutes.

If you have comments concerning the accuracy of these
time estimates or suggestions for making this form more
simple, we would be happy to hear from you. You can write
to both the Internal Revenue Service, Washington, DC
20224, Attention: IRS Reports Clearance Officer, T:-FP; and
the Office of Management and Budget, Paperwork
Reduction Project (1545-0967), Washington, DC 20503. DO
NOT send the form to either of these offices. Instead, see
Where To File, below.

Purpose of Form.—Use Form 8453-F to (1) authenticate the
electronic/magnetic media Form 1041, U.S. Fiduciary Income
Tax Return; (2) serve as a transmittal for any accompanying
paper schedules, statements, and magnetic media; and (3)
authorize the electronic/magnetic media filer to transmit via a
third-party transmitter.

Note: A tax return is not considered filed unless it is signed.
Form 8453-F is the signature document that completes the
filing of the Form(s) 1041 filed on electronic/magnetic media.

Who Must File.—Every estate or trust filing a 1991 Form
1041 via electronic/magnetic media must file a signed Form
8453-F.

Signature For Multiple-Return Filing.—A single signature
may be used for a multiple-return filing if the fiduciary is
authorized to sign each return. If you are filing more than one
return for which only one signature is provided, you must
attach a multiple-return information listing according to the
instructions given in Pub. 1437, Procedures for
Electronic/Magnetic Media Filing of U.S. Fiduciary Income
Tax Return, Form 1041, for Tax Year 1991. The information
listing must include the name control of each estate or trust,
its employer identification number (EIN), and the information
shown on lines 1 through 5 above for each return.

Where To File.—Send Form 8453-F to: Internal Revenue
Service, Philadelphia Service Center, ATTN: Magnetic Media
Unit—DP 115, 11601 Roosevelt Bivd., Philadelphia, PA
19154,

When To File.—An estate or trust must file its income tax
return by the 15th day of the 4th month following the close
of the tax year of the estate or trust. This filing date also
applies to returns filed electronically or on magnetic media.
For returns filed electronically, the transmitter must send the
signed Form 8453-F the same day the transmission is made.
For returns filed on magnetic tape or diskette, the transmitter
must send the signed Form 8453-F in the same package
with the corresponding tape or diskette.

*U.S, Government Printing Office: 1991-285-397/59675

Cat. No. 13890F

Form 8453-F (1991)