Declaration Control Number (DCN)

0 0 – – – 0

U.S. Individual Income Tax Transmittal OMB No. 1545-0074 8453 for an IRS e-file Return Form

Department of the Treasury

Internal Revenue Service

For the year January 1–December 31, 2009

© See instructions on back.

Use the

IRS label.

Otherwise,

please

print or

type.

Form 8453 (2009)

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

Your first name and initial Last name Your social security number

L

A

B

E

L

H

E

R

E

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

Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Important!

City, town or post office, state, and ZIP code

You must enter

your SSN(s) above.

¶ ¶

For Paperwork Reduction Act Notice, see back of form.

FILE THIS FORM ONLY IF YOU ARE ATTACHING ONE OR MORE

OF THE FOLLOWING FORMS OR SUPPORTING DOCUMENTS.

Check the applicable box(es) to identify the attachments.

Appendix A, Statement by Taxpayer Using the Procedures in Rev. Proc. 2009-20 to Determine a Theft Loss Deduction

Related to a Fraudulent Investment Arrangement

Form 3115, Application for Change in Accounting Method

Form 3468 - attach a copy of the first page of NPS Form 10-168a, Historic Preservation Certification Application (Part

2—Description of Rehabilitation), with an indication that it was received by the Department of the Interior or the State Historic 

Preservation Officer, together with proof that the building is a certified historic structure (or that such status has been

requested)

Form 4136 - attach the Certificate for Biodiesel and, if applicable, Statement of Biodiesel Reseller or a certificate from the

provider identifying the product as renewable diesel and, if applicable, a statement from the reseller

Form 5713, International Boycott Report

Form 8283, Noncash Charitable Contributions, Section A, (if any statement or qualified appraisal is required) or Section B,

Donated Property, and any related attachments (including any qualified appraisal or partnership Form 8283)

Form 8332, Release / Revocation of Release of Claim to Exemption for Child by Custodial Parent (or certain pages from a

divorce decree or separation agreement, that went into effect after 1984 and before 2009) (see instructions)

Form 8858, Information Return of U.S. Persons With Respect to Foreign Disregarded Entities

Form 8885, Health Coverage Tax Credit, and all required attachments

Schedule D-1, Continuation Sheet for Schedule D (Form 1040) (or a statement with the same information), if you elect not to 

include your transactions on the electronic short-term capital gain (loss) or long-term capital gain (loss) records

DO NOT SIGN THIS FORM.

Cat. No. 62766T

Form 8864 - attach the Certificate for Biodiesel and, if applicable, Statement of Biodiesel Reseller or a certificate from the

provider identifying the product as renewable diesel and, if applicable, a statement from the reseller

Form 2848, Power of Attorney and Declaration of Representative (or POA that states the agent is granted authority to sign

the return)

2009

Form 1098-C, Contributions of Motor Vehicles, Boats, and Airplanes (or equivalent contemporaneous written

acknowledgement)
Form 8453 (2009) 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 the box number only if

the post office does not deliver mail to

the home address.

Note. The address must match the

address shown on the electronically filed

tax return.

If you have suggestions for making this

form simpler, we would be happy to hear

from you. See the instructions for your

income tax return.

Line Instructions

Declaration control number (DCN). The

DCN is a 14-digit number assigned to

each tax return. It should be included in

your acknowledgement message. Clearly

print or type the DCN in the top left

corner of each Form 8453 after the IRS

has acknowledged receipt of the

electronic tax return. The first two digits

are the file identification number and are

always “00.” The next six digits are the

Example. The EFIN is 509325. The

batch and serial numbers are 00056.

The DCN is 00-509325-00056-0.

Name and address. If a peel-off name

and address label was received from the

IRS, put the label in the name area.

Cross out any incorrect information and

print the correct information. Add any

missing items, such as an apartment

number. If a label was not received, print

or type the information in the spaces

provided.

When and Where To File

If you are an ERO, you must mail Form

8453 to the IRS within 3 business days

after receiving acknowledgement that the

IRS has accepted the electronically filed

tax return.

Use Form 8453 to send any required

paper forms or supporting

documentation listed next to the

checkboxes on Form 8453 (do not send

Forms W-2, W-2G, or 1099-R).

Purpose of Form

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.

General Instructions

Social security number (SSN). Be sure

to enter the taxpayer’s SSN in the space

provided on Form 8453. If a joint tax

return, list the SSNs in the same order

as the first names.

Note. Do not mail a copy of an

electronically filed Form 1040, 1040A,

1040EZ, or 1040-SS to the Internal

Revenue Service (IRS).

The average time and expenses

required to complete and file this form

will vary depending on individual

circumstances. For the estimated

averages, see the instructions for your

income tax return.

CAUTION

Do not attach any form or

document that is not shown on

Form 8453 next to the

checkboxes. If you are required

to mail in any documentation

not listed on Form 8453, you cannot file

the tax return electronically.

Divorce decree or separation

agreement. If the divorce decree or

separation agreement went into effect

after 1984 and before 2009, the

noncustodial parent can attach certain

pages from the decree or agreement

instead of Form 8332. To be able to do

this, the decree or agreement must state

all three of the following.

1. The noncustodial parent can claim

the child as a dependent without regard

to any condition (such as payment of

support).

2. The other parent will not claim the

child as a dependent.

3. The years for which the claim is

released.

The noncustodial parent must attach all

of the following pages from the decree or

agreement.

● Cover page (include the other parent’s

SSN on that page).

● The pages that include all of the

information identified in (1) through (3)

above.

● Signature page with the other parent’s

signature and date of agreement.

Note. The noncustodial parent must

attach the required information even if it

was filed with a return in an earlier year.

Form 2848. An electronically transmitted

return signed by an agent must have a

power of attorney attached to Form

8453 that specifically authorizes the

agent to sign the return.

If you are filing your tax return using an

online provider, mail Form 8453 to the

IRS within 3 business days after you have

received acknowledgement from your

intermediate service provider and/or

transmitter that the IRS has accepted

your electronically filed tax return. If you

do not receive an acknowledgement, you

must contact your intermediate service

provider and/or transmitter.

Mail Form 8453 to:

Internal Revenue Service

Attn: Shipping and Receiving, 0254

Receipt and Control Branch

Austin, TX 73344-0254

Payments

Do not attach a payment to Form 8453.

Instead, mail it by April 15, 2010, with

Form 1040-V to the IRS at the applicable

address shown on that form. If a Form

1040-V is not available, see the

instructions for your tax return for other

ways to get forms or you can go to the

IRS website at www.irs.gov.

electronic filer identification number

(EFIN). The next five digits are the batch

number and the serial number. The last

digit is the year digit (for returns filed in

2010, the year digit is “0”).