U.S. Estate or Trust Income Tax Declaration and OMB No. 1545-0967

Signature for Electronic and Magnetic Media Filing Form 8453-F

Department of the Treasury

Internal Revenue Service

For calendar year 1995, or fiscal year beginning , 1995, and ending , 19

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) 2

3 Taxable income (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, I declare that the above amounts (or the amounts on the attached listing) agree with the amounts shown on the corresponding

lines of the electronic/magnetic media portion of the 1995 U.S. Income Tax Return(s) for Estates and Trusts. I 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. If I am not the transmitter, I consent that the return(s), including this declaration and

accompanying schedules and statements, be sent to the Internal Revenue Service by the return transmitter. I also consent to the IRS’ sending the

EMMRO and/or transmitter an acknowledgement of receipt of transmission and an indication of whether or not the return(s) is accepted, and, if rejected,

the reason(s) for the rejection.

Please

Sign

Here

Signature of fiduciary or officer representing fiduciary Date

Cat. No. 13890Y Form 8453-F (1995)

© ©

© See instructions on back.

Part III

Part I

Part II

I declare that I have reviewed the above estate or trust return(s) and that the entries on Form 8453-F are complete and correct to the best of my

knowledge. If I am only a collector, I am not responsible for reviewing the return(s), and only declare that this form accurately reflects the data on the

return(s). The fiduciary or an officer representing the fiduciary will have signed this form before I submit the return(s). I will give the fiduciary or officer

representing the fiduciary a copy of all forms and information to be filed with the IRS, and have followed all other requirements described in Pub. 1437,

Procedures for Electronic and Magnetic Media Filing of U.S. Income Tax Return for Estates and Trusts, Form 1041. If I am also the Paid Preparer, under

penalties of perjury I declare that I have examined the above estate or trust return(s) and accompanying schedules and statements, and to the best of

my knowledge and belief, they are true, correct, and complete. Declaration of preparer is based on all information of which the preparer has any

knowledge.

Date EMMRO’s social security number

EMMRO’s

Use Only

EMMRO’s

signature

Check if selfemployed ©

Firm’s name (or

yours if self-employed)

and address

EIN ©

ZIP code ©

©

©

Declaration of Fiduciary

Date Preparer’s social security number

Paid

Preparer’s

Use Only Preparer’s

signature

Check if selfemployed ©

Firm’s name (or

yours if self-employed)

and address

EIN ©

ZIP code ©

©

©

Check if 

also paid 

preparer ©

Under penalties of perjury, I declare that I have examined the above estate or trust return(s) and accompanying schedules and statements, and to the

best of my knowledge and belief, they are true, correct, and complete. Declaration of preparer is based on all information of which the preparer has

any knowledge.

Declaration of Electronic and/or Magnetic Media Return Originator (EMMRO) and Paid Preparer

(See instructions.)

For Paperwork Reduction Act Notice, see instructions.
Paperwork Reduction Act Notice

Who Must File

The time needed to complete and file this form will

vary depending on individual circumstances. The

estimated average time is:

If you have comments concerning the accuracy of

these time estimates or suggestions for making this

form simpler, we would be happy to hear from you.

You can write to the Tax Forms Committee, Western

Area Distribution Center, Rancho Cordova, CA

95743-0001. DO NOT send Form 8453-F to this

address. Instead, see Where To File below.

Where To File

When To File

Purpose of Form

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 or magnetic media.

Declaration of Electronic and/or Magnetic

Media Return Originator (EMMRO) and

Paid Preparer

A paid preparer who is not also the EMMRO must

sign Form 8453-F in the space for Paid Preparer’s

Use Only. A paid preparer who is also the EMMRO

should instead check the box in the EMMRO’s Use

Only section labeled “Check if also paid preparer.”

Form 8453-F (1995) Page 2

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.

Use Form 8453-F to (a) authenticate the electronic or

magnetic media Form 1041, U.S. Income Tax Return

for Estates and Trusts; (b) serve as a transmittal for

any accompanying paper schedules, statements, and

magnetic media; and (c) authorize the electronic or

magnetic media filer to transmit via a third-party

transmitter.

Every estate or trust filing a 1995 Form 1041 via

electronic or magnetic media must file a signed Form

8453-F.

Send Form 8453-F to: Internal Revenue Service,

Philadelphia Service Center, ATTN: Magnetic Media

Unit—DP 115, 11601 Roosevelt Blvd., Philadelphia, PA

19154.

An estate or trust must file its income tax return by the

15th day of the 4th month following the close of its tax

year. 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.

The EMMRO is one who deals directly with the

fiduciary and either prepares tax returns or collects

prepared tax returns, including Forms 8453-F, for

fiduciaries who wish to have the return of the estate or

trust electronically or magnetically filed. The EMMRO’s

signature is required by the IRS.

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.

The signer must attach a multiple-return information

listing according to the instructions in Pub. 1437,

Procedures for Electronic and Magnetic Media Filing of

U.S. Income Tax Return for Estates and Trusts, Form

1041. 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 for each return.

Learning about the law or the form 4 min.

Recordkeeping 7 min.

Preparing the form 18 min.

Copying, assembling, and sending 

the form to the IRS 20 min.

Printed on recycled paper