Declaration Control Number (DCN)

8453 U.S. Individual Income Tax Declaration OMB No. 1545-0996
Form 1. Fill
for Electronic Filing
Department of the Treasury For the year January 1-December 31, 1989 1989
Internal Revenue Service > See instructions on back.
/ Your first name and initial Last name “\\ Your social security number
L : :
Use IRS A ~ 7
label B | Hfajoint return, spouse's first name and initial Last name ‘Spouse's social security number
we, E : t
Otherwise, L Hi i
please 11 | Home address (number and street). (Ifa P.O. box, see instructions.) Apt. no. Telephone number (optional)
print or E ( )
R
type. E_ | City, town or post office, state and ZIP code For Paperwork Reduction Act

Notice, see instructions.
N L

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, print the most recently used last name here. >

Tax Return Information (Whole dollars only)

1 Total income (Form 1040, line 23; Form 1040A, line 11; Form 1040EZ, line 3) . 1
2 Total tax (Form 1040, line 55; Form 1040A, line 24; Form 1040EZ, line7) . 2
3 Federal income tax withheld. (Enter from Forms W-2, W-2G, and W-2P only. See instructions.) . 3
4 Refund (Form 1040, line 65; Form 1040A, line 27; Form 1040EZ, line 8) 4
Direct Deposit of Refund (See instructions on the back of this form. 7”
5 Name of financial institution and, if applicable, branch name
6 Routing transit number (RTN).
The RTN must begin with 01-12 or 21-32.
gq
= _| 7 Depositor account number (DAN)
Es
55
‘Sa| 8 Type of depositor account: [] savings C1 checking
SS
32 9 Proof of account: OD check O other
S310 Ownership of deposit account. Find the taxpayer's filing status and check the box that applies:
2
=< @ Single, head of household, or qualifying widow(er) . . . > CI sett
© Married filingjoint return... . . . . . . . . ®& CI Husband, 1 wife,or [1 Husband and Wite
Married filingseparateretun. . . . . oO Self OR oO Husband and Wife

Declaration of Taxpayer

Under penalties of perjury, | declare that | have compared the information contained on my return with the information | have provided to my electronic
return originator and that the amounts described in Part 1 above agree with the amounts shown on the corresponding lines of my 1989 Federal income tax
return. To the best of my knowledge and belief, my return is true, correct and complete. | consent that my return, including this declaration and
accompanying schedules and statements, be sent to the Internal Revenue Service by my electronic return originator. If I have elected Direct Deposit, |
declare that the information shown on lines 5 through 10 in Part II above is correct; I consent that my refund be directly deposited as designated
Part Il above; and I authorize the Internal Revenue Service to inform my electronic return originator and/or the transmitter whether my request for
Direct Deposit will be honored. If this return is a joint return and the refund 1s to be directly deposited, this is an irrevocable appointment of the other
spouse as an agent to receive the refund.

Please

Sign
Here Your signature Date Spouse's signature (if joint return, BOTH must sign)

magia Declaration of Electronic Return Originator (ERO)

I declare that | have reviewed the above taxpayer's return and that the entries on this form are complete and correct to the best of my knowledge. If Part Ilis
completed, | declare that | have verified the taxpayer's proof of account and that this proof of account agrees with the name shown on this declaration. |
have obtained the taxpayer's signature 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, and have followed all other requirements described in Pub. 1345, Revenue Procedure for Electronic Filing of Individual Income Tax

Returns (Tax Year 1989). Cheskitnat
Electronic ; Date paid preparer Your social security number
Return iad Creek

signature self-employe
Originator’s Firm: PTC yea > EI No.

jours if self-employe
Use Only Yd eddress ZIP code



Form 8453 (1989)

Page 2

Paperwork Reduction Act Notice

We ask for this information to carry out the
Internal Revenue laws of the United States.
We need it to ensure that taxpayers are
complying with these laws and to allow us to
figure and collect the right amount of tax.
You are required to give us this information.
The time needed to complete and file
this form will vary depending on individual
circumstances. The estimated average
time is:

Recordkeeping . 20 min.
Learning about the

law or the form . 3 min.
Preparing the form . 17 min.
Copying, assembling, and

sending the form to IRS . » 20 min.

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 the Internal Revenue
Service, Washington, DC 20224, Attention:
IRS Reports Clearance Officer, T:FP; or the
Office of Management and Budget,
Paperwork Reduction Project (1545-0936),
Washington, DC 20503.

Line-by-Line Instructions

Declaration Control
Number (DCN)

The DCN is a 14-digit number assigned to
each taxpayer account. The electronic
return originator (ERO) should enter this
number as follows:

Boxes Entry

1-2 File identification number
(always "00").

3-8 Electronic filer identification
number (EFIN) assigned by IRS.

9-11 Batch number (000 to 999)
assigned by the ERO.

12-13 Serial number (00 to 99)
assigned by the ERO.

14 Year digit (for 1990 the year

digit is “O”).

Example. The EFIN is 509325. The batch
number is 000. The serial number is 56.
The DCN should be 00-509325-00056-0.

Taxpayers will need to know the DCN
and the acceptance date of their electronic
return to contact their local district office to
check on their refund.

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 on the label. 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.
P.O. Box.—lf the post office does not
deliver mail to the taxpayer's home, and
the taxpayer has a P.O. box, enter the P.O.
box number instead of the address.

Note: The address must match the address
shown on the electronically filed Form
1040, Form 1040A, or Form 1040EZ.

Part |.—Tax Return
Information

Line 3.—Enter the total Federal income tax
withheld from Form(s) W-2, W-2G, and
W-2P only. Do not include any withholding
from Form(s) 1099.

Part IIl.—Direct Deposit
of Refund

Taxpayers can elect to have their refund
directly deposited by completing Part Il.
Line 6.—The routing transit number (RTN)
must contain 9 digits. If the RTN does not
begin with 01 through 12, or 21 through 32,
the Direct Deposit request will be rejected.
Line 7.—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 9.—To be eligible for Direct Deposit,
taxpayers must provide proof of account
ownership to their electronic return

originator. 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,
routing transit number, and depositor
account number preprinted on it. Financial
institutions will not accept payable-
through accounts for Direct Deposit.
Line 10.—The account designated to
receive the Direct Deposit must be in the
taxpayer's name. 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. If married filing jointly, the
account can be in either or both spouses’
names. If married filing separately, the
account can be in the taxpayer's name, or,
it can be a joint account in both spouses’
names.

Part III.—Declaration of
Taxpayer

The taxpayer's signature is required for all
returns. If Part Il is completed, this
signature allows the IRS to advise the
electronic return originator (ERO) and/or
the transmitter when a Direct Deposit
election will not be honored.

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:

e The total income (Form 8453, line 1)
differs from the amount on the electronic
return by more than $25, or

e The total tax (Form 8453, line 2), or the
total refund (Form 8453, line 4), differs
from the amount on the electronic return by
more than $5.

For more information, get Pub. 1345.

Part IV.—Declaration of
Electronic Return

Originator (ERO)

The ERO's signature is required by the IRS.
If the ERO is not the paid preparer for this
tax return, the ERO must check the box
provided.