Declaration Control Number (DCN)

0 5 0 – – –

U.S. Individual Income Tax Declaration OMB No. 1545-0936 8453 for Electronic Filing Form

Department of the Treasury

Internal Revenue Service

For the year January 1–December 31, 1994

© See instructions on back.

Your first name and initial Last name Your social security number L

A

B

E

L

H

E

R

E

Use the

IRS label.

Otherwise,

please

print or

type.

If a joint return, spouse’s first name and initial Last name Spouse’s social security number

Home address (number and street). If a P.O. box, see instructions. Apt. no. Telephone number (optional)

( )

City, town or post office, state, and ZIP code For Paperwork Reduction Act

Notice, see instructions.

Tax Return Information (Whole dollars only)

1 Total income (Form 1040, line 22; Form 1040A, line 14; Form 1040EZ, line 3) 1

2 Total tax (Form 1040, line 53; Form 1040A, line 27; Form 1040EZ, line 9) 2

Federal income tax withheld (Form 1040, line 54; Form 1040A, line 28a; Form 1040EZ, line 6). If

any is from Form(s) 1099, check here ©

3

3

4 Refund (Form 1040, line 62; Form 1040A, line 30; Form 1040EZ, line 10) 4

5 Amount you owe (Form 1040, line 64; Form 1040A, line 32; Form 1040EZ, line 11) 5

Direct Deposit of Refund (See instructions.)

6 Name of financial institution and, if applicable, branch name

7 Routing transit number (RTN)

The first two numbers of the RTN must

be 01 through 12 or 21 through 32.

8 Depositor account number (DAN)

10 Proof of account: Check Other

9 Type of account: Savings Checking

11 Ownership of account:

Attach Copy B of your

Forms W-2, W-2G, and

1099-R here.

Self Spouse Self and Spouse

Declaration of Taxpayer

Under penalties of perjury, I declare that the information I have provided to my

electronic return originator (ERO) and the amounts shown in Part I above agree

with the amounts shown on the corresponding lines of my 1994 Federal income

tax return. To the best of my knowledge and belief, my return is true, correct,

and complete. I consent that my return, this declaration, and accompanying

schedules and statements be sent to the IRS by my ERO. I consent that my

refund be directly deposited as designated in Part II above; I declare that

the information shown on lines 6 through 11 in Part II above is correct; and

I authorize the IRS to inform my ERO and/or transmitter whether my request

Sign

Here © Your signature Date Spouse’s signature. If a joint return, BOTH must sign. Date

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 understand that I am not responsible for reviewing the taxpayer’s

return; I declare that Form 8453 accurately reflects the data on the return. If Part

II is completed, I declare that I have verified the taxpayer’s proof of account and

it agrees with the name shown on this declaration. I have obtained the taxpayer’s

signature on Form 8453 before submitting this return to the IRS, have provided

the taxpayer with a copy of all forms and information to be filed with the IRS, Date Check Your social security number

if selfemployed

ERO’s

ERO’s signature

Use

Only

Firm’s name (or yours

if self-employed)

and address

E.I. No.

ZIP code

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. Declaration of preparer is based on all information of which the preparer has any knowledge.

Date Check Preparer’s social security no.

if selfemployed Preparer’s Paid signature

Preparer’s

Use Only

Firm’s name (or yours

if self-employed)

and address ZIP code

Part III

Part II

Part I

Part IV

©

©

©

©

© E.I. No.

Check if

also paid

preparer

If the taxpayer’s name changed during the past 3 years due to marriage, divorce, etc. and he or she filed a Federal income tax

return for such years using the former name, enter the most recently used last name here. ©

Cat. No. 62766T Form 8453 (1994)

for Direct Deposit will be honored. If I have filed a joint return and elected

Direct Deposit, this is an irrevocable appointment of the other spouse as an agent

to receive the refund. 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. If the processing of my return or refund is

delayed, I authorize the IRS to disclose to my ERO and/or the transmitter

the reason(s) for the delay, or when the refund was sent.

and have followed all other requirements described in Pub. 1345, Handbook for

Electronic Filers of Individual Income Tax Returns (Tax Year 1994). 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

declaration of Paid Preparer is based on all information of which the preparer

has any knowledge.

IRS Use Only—Do not write or staple in this space.
Form 8453 (1994) Page 2

Note: The account cannot include the name

of any other person unless the taxpayer’s

filing status on the return is married filing

jointly or married filing separately, and the

taxpayer’s spouse is the other name listed on

the account.

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.

P.O. Box.—If the post office does not deliver

mail to the taxpayer’s home and the taxpayer

has a P.O. box, enter the box number instead

of the home address.

Some financial institutions do not permit

the deposit of a joint refund into an individual

account. The IRS is not responsible when a

financial institution refuses a Direct Deposit

for this reason.

Note: The address must match the address

shown on the electronically filed Form 1040,

Form 1040A, or Form 1040EZ.

The time needed to complete and file this

form will vary depending on individual

circumstances. The estimated average time is

15 minutes.

Part I—Tax Return Information

Part III—Declaration of Taxpayer

If you have comments concerning the

accuracy of this time estimate or suggestions

for making this form simpler, we would be

happy to hear from you. You can write to

both the Internal Revenue Service,

Attention: Tax Forms Committee, PC:FP,

Washington, DC 20224; and the Office of

Management and Budget, Paperwork

Reduction Project (1545-0936), Washington,

DC 20503. DO NOT send this form to either

of these offices. Instead, see When and

Where To File below.

Line 5.—For balance due returns, do not

attach the check or money order to Form

8453. Instead, mail it with Form 1040-V to

the address shown on that form.

An electronically transmitted income tax

return will not be considered complete, and

therefore, filed, unless and until a Form 8453

signed by the taxpayer is received by the IRS.

The taxpayer’s signature allows the IRS to

advise the ERO and/or the transmitter if a

Direct Deposit election will not be honored. It

also allows the IRS to disclose to the ERO

and/or the transmitter the reason(s) for a

delay in processing the return or refund.

If the ERO makes changes to the electronic

return after Form 8453 has been signed by

the taxpayer but before it is transmitted, the

ERO must have the taxpayer complete and

sign a corrected Form 8453 if either of the

following applies:

Part II—Direct Deposit of Refund

Taxpayers can elect to have their refund

directly deposited by completing Part II.

Line 7.—The routing transit number (RTN)

must contain nine digits. If the RTN does not

begin with 01 through 12 or 21 through 32,

the Direct Deposit request will be rejected. ● The total income on line 1 differs from the

amount on the electronic return by more than

$25, or

● The total tax on line 2, the refund on line 4,

or the amount owed on line 5 differs from 

the amount on the electronic return by more

than $7.

Line 8.—The depositor account number

(DAN) can contain up to 17 alphanumeric

characters. Include hyphens but omit spaces

and special symbols. If fewer than 17

characters, enter the number from left to right

and leave the unused boxes blank.

Line 3.—Include any withholding from Form(s)

1099 in the amount you enter on line 3. Also,

be sure to check the box on line 3.

Line 10.—To be eligible for Direct Deposit,

taxpayers must provide proof of account

ownership to their ERO. An acceptable proof

of account ownership is a check, form,

report, or other statement generated by the

financial institution that has the taxpayer’s

name, RTN of the financial institution, and the

depositor account number preprinted on it.

Part IV—Declaration of Electronic

Return Originator (ERO) and Paid

Preparer

Line Instructions The ERO’s signature is required by the IRS.

Declaration Control Number (DCN).—The

DCN is a 14-digit number assigned by the

ERO to each taxpayer’s return. It must be

clearly typed or printed in the top left corner

of each Form 8453, one position per box,

prior to shipment to the IRS. The ERO should

enter this number only after the IRS has

acknowledged receipt of the electronic

portion of the return. The number should be

entered as follows:

A paid preparer must sign Form 8453 in the

space for Paid Preparer’s Use Only. Only

handwritten signatures are acceptable. But if

the paid preparer is also the ERO, do not

complete the paid preparer’s section. Instead,

check the box labeled “Check if also paid

preparer.”

For accounts that are payable through a

financial institution other than the one at

which the account is located, the taxpayer

must provide a document, such as an

account statement or account identification

card, showing the RTN of the bank or

institution where the account is located. A

deposit slip should not be used to verify the

RTN and account number because it can

contain internal routing numbers that are not

part of the RTN.

Refunds.—After the IRS has accepted the

return, the refund should be issued within 21

days. However, some refunds may be

temporarily delayed as a result of compliance

reviews to ensure that the returns are

accurate.

Boxes Entry

File identification number

(always “00”)

1–2 Automated Refund Information.—Refund

information is available on Tele-Tax. See the

instruction booklet for Form 1040, 1040A, or

1040EZ for a list of Tele-Tax information

telephone numbers.

Electronic filer identification

number (EFIN) assigned by the

IRS

3–8 If there is any doubt about the correct RTN,

the taxpayer should contact the financial

institution and ask for the correct RTN for

Direct Deposit (Electronic Funds Transfers). Batch number (000 to 999)

assigned by the ERO

9–11

Serial number (00 to 99)

assigned by the ERO

12–13

Note: Some financial institutions may not

accept Direct Deposits into accounts that are

payable through another bank or financial

institution, including credit unions. Year digit (for 1995, the year

digit is “5”)

14

Line 11.—The account designated to receive

the Direct Deposit must be in the taxpayer’s

name. If the taxpayer’s filing status on the

return is married filing jointly, the account can

be in either or both spouses’ names. If the

filing status is married filing separately, the

account can be in the taxpayer’s name, or it

can be a joint account in both spouses’

names.

Example. The EFIN is 509325. The batch

number is 000. The serial number is 56. The

DCN should be 00-509325-00056-5.

Name, Address, and Social Security

Number.—If the taxpayer received a mailing

label from the IRS, place the label in the

name area. Cross out any errors and print the

correct information. Add any missing items,

such as apartment number. If the taxpayer

did not receive a label, print or type the

information in the spaces provided. Please

verify that the social security number (SSN) is

clear and correct. An incorrect or missing

SSN may delay any refund. If a joint return,

be sure the names and SSNs are listed in the

same order.

When and Where To File

This form must be mailed to the service

center where the electronic return was

transmitted on the next working day after the

ERO has received acknowledgment from the

IRS that the return was accepted. Only the

Andover, Austin, Cincinnati, Memphis, and

Ogden Service Centers can accept

electronically filed returns. For more details,

get Pub. 1345, Handbook for Electronic Filers

of Individual Income Tax Returns (Tax Year

1994). It contains step-by-step mailing

instructions and complete addresses for each

of these service centers.

Use Form 8453 to:

● Authenticate the electronic portion of Form

1040, 1040A, or 1040EZ,

● Transmit any accompanying paper

schedules and statements,

● Authorize the ERO to transmit via a

third-party transmitter, and

● Provide the taxpayer’s consent to directly

deposit any overpayment.

Purpose of Form

Printed on recycled paper