Form 8453 

Department of the Treasury 

Internal Revenue Service 

U.S. Individual Income Tax Transmittal 

for an IRS e-file Return

For the year January 1–December 31, 2012

▶ See instructions on back.

OMB No. 1545-0074

2012

Declaration Control Number (DCN)

0 0 – – – 3 IRS Use Only—Do not write or staple in this space.

Please 

print or 

type. 

p 

R 

I 

N 

T 

C 

L 

E 

A 

R 

L 

Y

Your first name and initial Last name Your social security number 

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

▲ Important! 

You must enter 

your SSN(s) above. 

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

City, town or post office, state, and ZIP code (If a foreign address also complete spaces below.)

Foreign country name Foreign province/county Foreign postal code

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

acknowledgement)

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

return)

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 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 8885, Health Coverage Tax Credit, and all required attachments

Form 8949, Sales and Other Dispositions of Capital Assets, (or a statement with the same information), if you elect not to 

report your transactions electronically on Form 8949

DO NOT SIGN THIS FORM.

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 62766T Form 8453 (2012)
Form 8453 (2012) Page 2

General Instructions

Purpose of Form

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).

▲!

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.

Note. Do not mail a copy of an

electronically filed Form 1040, 1040A,

1040EZ, or 1040-SS to the Internal

Revenue Service (IRS).

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.

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

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 

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 

2013, the year digit is “3”).

Example. The EFIN is 509325. The

batch and serial numbers are 00056. The 

DCN is 00-509325-00056-3.

Name and address. Print or type the 

information in the spaces provided. If 

using a foreign address, do not 

abbreviate the country name.

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.

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.

Payments

Do not attach a payment to Form 8453. 

Instead, mail it by April 15, 2013, 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 

IRS.gov.

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.

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.