Declaration Control Number (DCN)

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8 45 3 U.S. Individual Income Tax Declaration OMB No. 1545-0936
re
om for Electronic Filing
Department of the Treasury For the year January 1-December 31, 1990
Internal Revenue Service > See instructions on back.
/ Your first name and initial Last name “\ Your social security number
L H i
Use! RS 8. | ifaiomnt return, spouse's first name and initial Last name Spouse's social security number
. 8 4
Otherwise, L i i
please | Home address (number and street). (fa 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.

\
J Part Tax Return Information (Whole dollars only)

1 Total income (Form 1040, line 23; Form 1040A, line 14; Form 1040EZ,line3). . . . . 2 1 we 1
2 Total tax (Form 1040, line 54; Form 1040A, line 27; Form 1040E7Z, line 7) . 2
3 Federal income tax withheld (Form 1040, line 55; Form 1040A, line 28a; Form 1040E2, line 6). if any is
from Form(s) 1099, check here > : 3
4 Refund (Form 1040, line 64; Form 1040A, line 30; Form 10407, line 8) . coe ee LA
5 Amount you owe (Form 1040, line 66; Form 1040A, line 32; Form 1040EZ, line 9) eee [5
Direct Deposit of Refund (See instructions on back.)
6 Name of financial institution and, if applicable, branch name
7 Routing transit number (RTN)
av The first two numbers of the RTN must.
2 be 01 through 12 or 21 through 32.
ra
Es 8 Depositor account number (DAN)
ir
rr
a
33 9 Type of depositor account : O Savings O Checking 10 Proof of account: oO Check O Other
Se
a
ag 11 Ownership of deposit account. Find the taxpayer's filing status and check the box that applies:
y
se
£ @ Single, head of household, or qualifying widow(er) . . «> O sett
=<
e Married filingjointretun . 2. 1 1 we ee ee Oo Self oO Spouse OR Oo Self and Spouse
Married filing separateretun. . . . . . . . . . » LJ seit on [7] Setfand Spouse

ixaaug Declaration of Taxpayer

Under penalties of perjury, | declare that I 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 | above agree with the amounts shown on the corresponding lines of my 1990 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 | have elected Direct Deposit, | declare that the information shown on lines 6 through 11 in Part Il above is correct; | consent that my
refund be directly deposited as designated in Part Il above; and | 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 jomnt 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. If | have elected to make an ADEPT payment, | understand that if the IRS does not receive full and timely payment of my tax liability, | will
remain liable for the tax liability and all applicable interest and penalties.

Please |

Sign >
Here Your signature Date Spouse's signature (if joint return, BOTH must sign) Date
GEMM Deciaration of Electronic Return Originator (ERO) and Paid Preparer

I declare that ! have reviewed the above taxpayer's return and that the entries on Form 8453 are complete and correct to the best of my knowledge. (EROs who are collectors are
not responsible for reviewing the taxpayer's return; however, they must ensure that Form 8453 accurately reflects the data on the return.) If Part Ii is 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, Procedures for Electronic Filing of Individual Income Tax Returns (Tax Year 1990).

Date Your social security number
ERO's > Checkif
ERO’s signature settemployed [_]
Firm’s name (or IN
Use Only fomesrans tremployed) » EI. No.
and address ZIP code

{Under penalties of perury 1 deciare that | 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 preparer has any knowleds

Paid Preparer’s Date Checkit Preparer’ soca security no.
i , Sehature self-employed O H i
Preparet’s | Fin spare (ray r E.I. No.

ours if selfemploye
Use Only yru'scctesseTM ZIP code



Form 8453 (1990)

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.

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 more simple, we would be
happy to hear from you. You can write to both
the Internal Revenue Service, Washington,
DC 20224, Attention: IRS Reports Clearance
Officer, T:FP; 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.

Changes You Should Note

@ Balance due returns from approved
electronic return originators will be accepted
by the Cincinnati Service Center for taxpayers
who live in Georgia, Indiana, Kentucky,
Michigan, Ohio, and West Virginia, and by the
Ogden Service Center for taxpayers who live in
lowa, Utah, and Washington. Balance due
returns will also be accepted from approved
EROs by the Andover Service Center for
taxpayers from Connecticut, Maine,
Massachusetts, New Hampshire, Rhode
Island, and Vermont, but only if payment is
made using the ADEPT system. See the
instructions for line 5.

@ 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-by-Line Instructions

Declaration Control Number (DCN). The
DCN is a 14-digit number assigned by the
electronic return originator (ERO) to each
taxpayer's return. The ERO should enter this
number only after IRS has acknowledged
receipt of the electronic portion of the return.
The number should be entered 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 1991, the year
digit is “1").

Example. The EFIN is 509325. The batch
number is 000. The serial number is 56. The
DCN should be 00-509325-00056-1.

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. If 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 5. For balance due returns, do not attach
the check or money order to Form 8453.
Instead, mail it with Form 9282 to the address
shown on that form.

If payment is made using the Automated
Deposit of Electronic Payments for Taxes
(ADEPT) system, please write “ADEPT” in the
top margin above the title of Form 8453.

Note: ADEPT is a test system offered only to
certain approved filers that send electronic
returns to the Andover Service Center.

Part Il.—Direct Deposit of Refund

Taxpayers can elect to have their refund
directly deposited by completing Part Il.

Line 7. 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 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 10. 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, RTN of the financial
institution, and the depositor account number
preprinted on it.

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.

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).

Note: Some financial institutions may not
accept Direct Deposits into accounts that are
payable through another bank or financial
institution, including credit unions.

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.

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 among the other names listed on the
account.

Some financial institutions do not permit the
deposit of a joint refund into an individual
account. IRS is not responsible when a
financial institution refuses a Direct Deposit
for this reason.

Part III. —Declaration of Taxpayer

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 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 if 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:

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

@ The total tax (Form 8453, line 2), the total
refund (Form 8453, line 4), or the amount
owed (Form 8453, line 5), differs from the
amount on the electronic return by more

than $5.

For more information, see Pub. 1345.
Part IV.—Deciaration of Electronic

Return Originator (ERO) and Paid
Preparer

The ERO's signature is required by the IRS.

A paid preparer must also sign Form 8453
in the space for Paid Preparer’s Use Only,
even if the paid preparer is also the ERO. Only
handwritten signatures are acceptable.

Refunds. If the taxpayer elects Direct Deposit,
the taxpayer can usually expect the refund
within 2-3 weeks after IRS acknowledges
receipt of the return. If the taxpayer does not
elect Direct Deposit, the refund should be
received in about 3 weeks.

Automated Refund Information. Refund
information is available on Tele-Tax. See the
instruction booklet for Form 1040, 1040A, or
10408Z, fora list of Tele-Tax information
telephone numbers. Tele-Tax will have refund
information 3 weeks after IRS has
acknowledged receipt of the return.

If 4 weeks have passed and Tele-Tax doesn’t
have information about the refund, the
taxpayer can call the telephone assistance
number listed in the instruction booklet for
Form 1040, 1040A, or 1040€Z. Taxpayers will
need to know the DCN and the
acknowledgment date of their electronic
return before calling for assistance.