Part III

U.S. Nonresident Alien Income Tax Declaration 8453-NR for Electronic Filing

Department of the Treasury

Internal Revenue Service

For the year January 1–December 31, 2001

 See instructions on back.

Taxpayer’s first name and initial Last name Identifying number

Tax Return Information (Whole dollars only)

1 Adjusted gross income (Form 1040NR, line 33) 1

2 Total tax (Form 1040NR, line 54) 2

3 Total payments (Form 1040NR, line 64) 3

4 Refund (Form 1040NR, line 66a) 4

5 Amount you owe (Form 1040NR, line 68) 5

Direct Deposit of Refund (Optional—See instructions.)

6 Routing number The routing number must be nine digits, and the first

two must be 01 through 12 or 21 through 32.

7 Account number

Declaration of Taxpayer (Sign only if Part I is completed.)

Under penalties of perjury, I declare that the information I have given my electronic return originator (ERO) and the amounts in Part I above (or the

amounts on the attached listing) agree with the amounts on the corresponding lines of the electronic portion of my 2001 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 Your signature Date

Declaration of Electronic Return Originator (ERO) and Paid Preparer (See instructions.)

Date ERO’s SSN or PTIN

Check if selfemployedERO’s

ERO’s signature

Use Only Firm’s name (or

yours if self-employed),

address, and ZIP code

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.

Date Preparer’s SSN or PTIN

Preparer’s

signature Paid

Preparer’s

Use Only

EIN

Phone no. ( )

Cat. No. 13115A Form 8453-NR (2001)

Part I



I declare that I have reviewed the above taxpayer’s return and that the entries on Form 8453-NR 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 Procedures for Electronic Filing of U.S. Nonresident Alien Income Tax Returns, Form 1040NR,

for Tax Year 2001. 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.

Part IV





Firm’s name (or

yours if self-employed),

address, and ZIP code

Check if  self-employed



OMB No. 1545-1274

For Paperwork Reduction Act Notice, see back of form.

Part II

I consent that my refund be directly deposited as designated in Part II, and declare that the information on lines 6 through 8 is correct.

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. Form

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

Check if

also paid

preparer

8 Type of account: Checking Savings

9a

b

2001
Form 8453-NR (2001) Page 2

Purpose of Form

Use Form 8453-NR to:

● Authenticate the electronic portion of Form 1040NR, U.S.

Nonresident Alien Income Tax Return,

● Send any accompanying paper schedules or statements,

● Authorize the electronic return originator (ERO) to transmit via

a third-party transmitter, and

● Confirm the taxpayer’s consent to directly deposit any refund

into an account of a U.S. financial institution located in the

United States.

Who Must File

Every nonresident alien filing a 2001 Form 1040NR electronically

must file a signed 2001 Form 8453-NR.

Note: Some financial institutions may not accept direct deposits

into accounts that are payable through another bank or financial

institution, including credit unions. Also, the financial institution

must be a U.S. financial institution located in the United States.

The IRS cannot make a direct deposit to a foreign bank or a

foreign branch of a U.S. bank.

Signature for Multiple-Return Filing

A single signature may be used for a multiple-return filing by a

person authorized to sign each return. If you are filing more than

one return for which only one signature is provided, enter “See

attached Multiple-Return Information Listing” in the space

provided for the taxpayer’s name. You must also attach a

Multiple-Return Information Listing according to the instructions

given in the Procedures for Electronic Filing of U.S. Nonresident

Alien Income Tax Returns, Form 1040NR, for Tax Year 2001.

The information listing must include the name control for each

taxpayer, identifying number, and the information requested on

lines 1 through 5 of Form 8453-NR for each return.

Part III—Declaration of Taxpayer

An electronically transmitted return will not be considered

complete, and therefore filed, unless and until a Form 8453-NR

signed by the taxpayer is received by the IRS.

When To File

This form must be filed when the electronic return is transmitted.

If the ERO makes changes to the electronic return after

Form 8453-NR has been signed by the taxpayer but before it is

transmitted and either 1 or 2 below applies, the ERO must have

the taxpayer complete and sign a corrected Form 8453-NR.

Where To File

1. The adjusted gross income on line 1 differs from the

amount on the electronic return by more than $50 or

Send Form 8453-NR to:

Internal Revenue Service

Philadelphia Submission Processing Center

ATTN: DP 2720, ELF Processing Support Section

11601 Roosevelt Blvd.

Philadelphia, PA 19154

2. The total tax on line 2, the total payments on line 3, the

refund on line 4, or the amount owed on line 5 differs from the

amount on the electronic return by more than $14.

Part IV—Declaration of Electronic Return

Originator (ERO) and Paid Preparer

Part II—Direct Deposit of Refund

Note: Taxpayers who want to have their refund directly

deposited must complete Part II and check the box on line 9a.

Line 6. The routing number must be nine digits, and the first two

must be 01 through 12 or 21 through 32. Otherwise, the direct

deposit will be rejected and a check sent instead.

Line 7. The account number can be up to 17 characters (both

numbers and letters). Include hyphens but omit spaces and

special symbols. Enter the number from left to right and leave

any unused boxes blank.

Refunds. After the IRS has accepted the return, the refund

should be issued within 3 weeks. However, some refunds may

be delayed because of compliance reviews to ensure that

returns are accurate.

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 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 Where To File on this page.

The IRS requires the ERO’s signature. A paid preparer must sign

Form 8453-NR 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.”

Note: All taxpayers must check either the box on line 9a or the

box on line 9b.

You are not required to provide the information requested on

a form that is subject to the Paperwork Reduction Act 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.

A check, form, report, or other statement generated by the

financial institution should show the routing number and account

number. On checks, the check number usually follows the

account number at the bottom of the check. Be sure not to

include the check number.

For accounts payable through a financial institution other than

the one at which the account is located, the taxpayer should use

a document, such as an account statement or account

identification card, showing the routing number of the bank or

institution where the account is located. A deposit slip should

not be used because it can contain internal routing numbers. If

there is any doubt about the correct routing number, the

taxpayer should contact the financial institution and ask for the

correct routing number for direct deposit (Electronic Funds

Transfers).

The taxpayer’s signature allows the IRS to disclose to the

ERO and/or transmitter the reason(s) for a delay in processing

the return or refund. In the case of a taxpayer who is applying

for a refund anticipation loan or similar product, the taxpayer’s

signature also allows the IRS to advise the ERO and/or

transmitter if a refund offset may occur.

Note: If the paid preparer’s signature cannot be obtained on

Form 8453-NR, you may attach a copy of Form 1040NR instead.

Attach only pages 1 and 2, and write “COPY—DO NOT

PROCESS” on each page.