Declaration Control Number (DCN)

0 0 0 – – –

U.S. Individual Income Tax Declaration OMB No. 1545-1397 8453-OL for an e-file On-Line Return

Form

Department of the Treasury

Internal Revenue Service

For the year January 1–December 31, 1999

 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 back of form.

Tax Return Information (Whole dollars only)

1 Total income (Form 1040, line 22; Form 1040A, line 14; Form 1040EZ, line 4) 1

2 Total tax (Form 1040, line 56; Form 1040A, line 34; Form 1040EZ, line 10) 2

3 Federal income tax withheld (Form 1040, line 57; Form 1040A, line 35; Form 1040EZ, line 7) 3

4 Refund (Form 1040, line 66a; Form 1040A, line 41a; Form 1040EZ, line 11a) 4

5 Amount you owe (Form 1040, line 68; Form 1040A, line 43; Form 1040EZ, line 12). See instructions 5

Declaration of Taxpayer

I consent that my refund be directly deposited as designated in the electronic portion of my 1999 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.

Sign

Here  Your signature Date

Part I

Cat. No. 15907C Form 8453-OL (1999)

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

Part II

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 on-line service provider and/or transmitter and the

amounts in Part I above agree with the amounts on the corresponding lines of the electronic portion of my 1999 Federal

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

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

IMPORTANT!

You must enter

your SSN(s) above.



6a

b I do not want direct deposit of my refund or I am not receiving a refund.

I authorize the U.S. Treasury and its designated Financial Agents to initiate an ACH debit (automatic withdrawal)

entry to my financial institution account indicated for payment of my Federal taxes owed, and my financial institution

to debit the entry to my account. This authorization is to remain in full force and effect until the U.S. Treasury’s

Financial Agents receive notification from me of the termination. To revoke this payment authorization, 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 my electronic payment of taxes to receive

confidential information necessary to answer inquiries and resolve issues related to my payment.

c

1999
Form 8453-OL (1999) Page 2

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. Enter your box number only if

the post office does not deliver mail to

your home.

Note: The address must match the address

shown on your electronically filed return.

Part II—Declaration of Taxpayer

● Routing number

Line Instructions

Declaration Control Number (DCN). The

DCN is a 14-digit number assigned to your

return by your on-line service provider

and/or transmitter. It is included in your

acknowledgment message. Clearly type or

print the DCN in the top left corner of Form

8453-OL. The first two digits are always

Refunds. Your refund should be issued

within 3 weeks after the IRS has accepted

your return. However, some refunds may

be delayed because of compliance reviews

to ensure that returns are accurate. Refund

information is available on TeleTax. Call

1-800-829-4477.

Example. The EFIN is 509325. The

batch number is 000. The serial number is

56. The DCN is 00-509325-00056-0.

Name and Address. If you received a

peel-off name and address label from the

IRS, put the label in the name area. Cross

out any errors and print the correct

information. Add any missing items, such

as your apartment number. If you did not

receive a label, print or type the

information in the spaces provided.

When and Where To File

You must mail this form to the IRS on the

next working day after you have received

acknowledgment from your on-line service

provider and/or transmitter that the IRS

has accepted your electronically filed

return. The address should be included in

your acknowledgment message. If not,

mail Form 8453-OL to the IRS at the

applicable address shown in the chart

below.

Purpose of Form

Use Form 8453-OL to:

Who Must File

If you are filing a 1999 Form 1040, 1040A,

or 1040EZ through an on-line service

provider and/or transmitter, you must file a

signed 1999 Form 8453-OL with the IRS. If

you do not, you will not have filed a valid

return for 1999, and we may not allow you

to file electronically next year.

You are not required to provide the

information requested on a form that is

subject to the Paperwork Reduction Act

The time needed to complete and file

this form will vary depending on individual

IF you live in . . . THEN mail Form 8453-OL

to this address . . .

Connecticut, Delaware, District of Columbia, Maine,

Maryland, Massachusetts, New Hampshire, New Jersey,

New York, Pennsylvania, Rhode Island, Vermont, Virginia,

and all APO and FPO addresses (except Asian/Pacific)

Illinois, Iowa, Kansas, Minnesota, Missouri, New Mexico,

Oklahoma, Texas, Wisconsin

Florida, Indiana, Kentucky, Michigan, Ohio,

South Carolina, West Virginia

Alabama, Arkansas, Georgia, Louisiana, Mississippi,

North Carolina, Tennessee

Alaska, Arizona, California, Colorado, Hawaii, Idaho,

Montana, Nebraska, Nevada, North Dakota, Oregon,

South Dakota, Utah, Washington, Wyoming, and all

Asian/Pacific APO and FPO addresses

AND mail any payment with

Form 1040-V to this address . . .

Receipt and Control Branch

Shipping and Receiving

310 Lowell Street

Andover, MA 05501

Receipt and Control Branch

Shipping and Receiving

P.O. Box 1231

Austin, TX 78767-1231

Cincinnati, OH 45999

P.O. Box 1898

Attn: 8453-OL

Memphis, TN 38101

Stop 6052

1160 West 1200 South

Ogden, UT 84201

P.O. Box 371361

Pittsburgh, PA 15250-7361

P.O. Box 970016

St. Louis, MO 63197-0016

P.O. Box 6223

Chicago, IL 60680-6223

P.O. Box 7704

San Francisco, CA 94120-7704

P.O. Box 1214

Charlotte, NC 28101-1214

General Instructions

● Authenticate the electronic portion of

your 1999 Form 1040, 1040A, or 1040EZ,

● Provide your consent to directly deposit

any refund or authorize an ACH debit

(automatic withdrawal).

Social Security Number (SSN). Be sure to

enter your SSN in the space provided on

Form 8453-OL. If a joint return, list the

SSNs in the same order as the first names.

Note: You must check the box on line 6a,

6b, or 6c.

● Account number

● Type of account (checking or savings)

● Debit amount

● Debit date (date you want the debit to

occur, but not later than April 17, 2000).

Your electronically transmitted return will

not be considered complete, and therefore

filed, unless and until the IRS receives your

signed Form 8453-OL. If a joint return,

your spouse must also sign.

mail it by April 17, 2000, with Form 1040-V

to the IRS at the applicable address shown

in the chart below. If you do not have a

Form 1040-V, you may be able to get it

from your on-line service provider and/or

transmitter. You can also see your tax

return instruction booklet for other ways to

get forms, including using the IRS’s

Internet Web Site (www.irs.gov).

Part I—Tax Return Information

Line 5. Do not include any payment with

Form 8453-OL. The method of payment

depends on whether you check the box on

line 6b or 6c. For details, see the

instructions for Part II.

“00”. The next six digits are the electronic

filer identification number (EFIN). The next

five digits are the batch number and serial

number. The “0” represents the year the

return is filed (2000).

If you check the box on line 6c, you

must ensure that the following information

relating to the financial institution account

is provided in the electronic portion of the

tax return.

Your signature allows the IRS to disclose

to your on-line service provider and/or

transmitter the reason(s) for a delay in

processing your return or refund. If you are

applying for a refund anticipation loan or

similar product, your signature also allows

the IRS to advise your on-line service

provider and/or transmitter if a refund

offset may occur.

If there is an amount on line 5 and you

check the box on line 6b and are paying

by check or money order, do not attach

your payment to Form 8453-OL. Instead,

unless the form displays a valid OMB

control number. Books or records

relating to a form or its instructions must

be retained as long as their contents may

become material in the administration of

any Internal Revenue law. Generally, tax

returns and return information are

confidential, as required by Internal

Revenue Code section 6103.

circumstances. The estimated average time

is 15 minutes. 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 the Tax Forms

Committee, Western Area Distribution

Center, Rancho Cordova, CA 95743-0001.

DO NOT send the form to this address.

Instead, see When and Where To File on

this page.

● Send any accompanying paper

schedules or statements, and