Declaration Control Number (DCN)

0 6 0 – – –

U.S. Individual Income Tax Declaration 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, 2005

 See instructions on back.

Use the

IRS label.

Otherwise,

please

print or

type.

Daytime phone number

( )

Tax Return Information (Whole dollars only)

1 Adjusted gross income (Form 1040, line 38; Form 1040A, line 22; Form 1040EZ, line 4) 1

2 Total tax (Form 1040, line 63; Form 1040A, line 38; Form 1040EZ, line 10) 2

3 Federal income tax withheld (Form 1040, line 64; Form 1040A, line 39; Form 1040EZ, line 7) 3

4 Refund (Form 1040, line 73a; Form 1040A, line 45a; Form 1040EZ, line 11a) 4

5 Amount you owe (Form 1040, line 75; Form 1040A, line 47; Form 1040EZ, line 12) 5

Declaration of Taxpayer (Sign only after Part I is completed.) Be sure to keep a copy of your tax return.

Under penalties of perjury, I declare that I have examined a copy of my electronic individual income tax return and accompanying schedules and statements

for the tax year ending December 31, 2005, and to the best of my knowledge and belief, it is true, correct, and complete. I further declare that the amounts

in Part I above are the amounts shown on the copy of my electronic income tax return. I consent to allow my electronic return originator (ERO) to send my

return to the IRS and to receive from the IRS (a) an acknowledgment of receipt or reason for rejection of the transmission, (b) an indication of any refund

offset, (c) the reason for any delay in processing the return or refund, and (d) the date of any refund.

Sign

Here  Your signature Date Spouse’s signature. If a joint return, both must sign. Date

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

I declare that I have reviewed the above taxpayer’s return and that the entries on Form 8453 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 Pub. 1345, Handbook for Authorized IRS e-file Providers of Individual Income Tax Returns. 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.

Date Check ERO’s SSN or PTIN

if selfemployed

ERO’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 Paid signature

Preparer’s

Use Only

Firm’s name (or

yours if self-employed),

address, and ZIP code Phone no. ( )

Part I









 EIN

Cat. No. 62766T Form 8453 (2005)

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. If I have filed a joint Federal and state tax return and there is an error on my state return,

I understand my Federal return will be rejected.

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

I consent that my refund be directly deposited as designated in the electronic portion of my 2005 Federal income tax return. If I have filed a joint

return, this is an irrevocable appointment of the other spouse as an agent to receive the refund.

6a

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

Check if

also paid

preparer

b

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.



I authorize the U.S. Treasury and its designated Financial Agent to initiate an ACH electronic funds withdrawal entry to the financial institution

account indicated in the tax preparation software for payment of my Federal taxes owed on this return and/or a payment of estimated tax. I further

understand that this authorization may apply to future Federal tax payments that I direct to be debited through the Electronic Federal Tax Payment

System (EFTPS). In order for me to initiate future payments, I request that the IRS send me a personal identification number (PIN) to access EFTPS.

This authorization is to remain in full force and effect until I notify the U.S. Treasury Financial Agent to terminate the authorization. To revoke a

payment, I must contact the U.S. Treasury Financial Agent at 1-888-353-4537 no later than 2 business days prior to the payment (settlement)

date. I also authorize the financial institutions involved in the processing of the electronic payment of taxes to receive confidential information

necessary to answer inquiries and resolve issues related to the payment.

c

For Paperwork Reduction Act Notice, see back of form.

Part II

Part III

Check

if selfemployed

2005
Form 8453 (2005) 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

taxpayer’s home.

Note. The address must match the address

shown on the electronically filed 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.

Part II—Declaration of Taxpayer

Taxpayer signatures. An electronically

transmitted return will not be considered

complete, and therefore filed, unless and until

a Form 8453 signed by the taxpayer is

received by the IRS. A Form 8453 signed by

an agent must have a power of attorney

attached that specifically authorizes the agent

to sign the return. To do this, you can use

Form 2848, Power of Attorney and

Declaration of Representative.

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 (a) the amount

on line 1 differs from the amount on the

electronic return by more than $50, or (b) any

amount on lines 2 through 5 differs from the

amount on the electronic return by more than

$14.

Part III—Declaration of Electronic

Return Originator (ERO) and Paid

Preparer

Line Instructions

Declaration control number (DCN). The DCN

is a 14-digit number assigned by the ERO to

each return. Clearly print or type the DCN in

the top left corner of each Form 8453 after the

IRS has acknowledged receipt of the

electronic 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) assigned by the

IRS. The next three digits are the batch

number (000 to 999) assigned by the ERO. The

next two digits are the serial number (00 to 99)

assigned by the ERO. The last digit is the year

digit (for returns filed in 2006, the year digit is

“6”).

The IRS requires the ERO’s signature. A paid

preparer must sign Form 8453 in the space

for Paid Preparer’s Use Only. 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.”

Refund information. You can check on the

status of a 2005 refund if it has been at least

3 weeks from the date you filed the return. To

check on the status of a 2005 refund, do one

of the following:

Example. The EFIN is 509325. The batch

number is 000. The serial number is 56. The

DCN is 00-509325-00056-6.

Name and address. If the taxpayer received

a peel-off name and address label 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

When and Where To File

The ERO must mail Form 8453 to the IRS

within 3 business days after receiving

acknowledgement that the IRS has accepted

the electronically filed return. Mail Form 8453

to the IRS at the applicable address shown in

the chart below.

Use Form 8453 to:

● Authenticate the electronic portion of Form

1040, 1040A, or 1040EZ,

● Send any required paper forms (do not

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

● Authorize the electronic return originator

(ERO) to transmit via a third-party transmitter,

and

● Provide the taxpayer’s consent to directly

deposit any refund and/or authorize an

electronic funds withdrawal for payment of

federal taxes owed and/or a payment of

estimated tax.

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.

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.

General Instructions

Note. If the paid preparer’s signature cannot

be obtained on Form 8453, you can attach a

copy of Form 1040, 1040A, or 1040EZ

instead. Attach only pages 1 and 2, and enter

“COPY—DO NOT PROCESS” on each page.

Social security number (SSN). Be sure to

enter the taxpayer’s SSN in the space

provided on Form 8453. If a joint return, list

the SSNs in the same order as the first

names.

Note. The taxpayer must check all applicable

boxes on line 6.

● Routing number.

● Account number.

● Type of account (checking or savings).

● Debit amount.

● Debit date (date the taxpayer wants the

debit to occur).

If there is an amount on line 5 and the

taxpayer checks box 6b and is paying by

check or money order, mail the payment by

April 17, 2006, with Form 1040-V to the

applicable address shown on that form.

Part I—Tax Return Information

Line 5. Do not include any payment with

Form 8453. The method of payment depends

on whether the taxpayer checks the box on

line 6b or 6c. For details, see the instructions

for Part II.

If the taxpayer checks box 6c, the taxpayer

must ensure that the following information

relating to the financial institution account is

provided in the tax preparation software.

Instead of filing Form 8453, the

taxpayer may be able to sign the

return electronically using a

self-selected personal identification number

(PIN). For details, go to the IRS website at

www.irs.gov or see Pub. 1345.

● Go to www.irs.gov and click on Where’s

My Refund.

● Call 1-800-829-4477 for automated refund

information and follow the recorded

instructions.

● Call 1-800-829-1954.

TIP

Form 8453 can be faxed between the

taxpayer and the ERO. The ERO must receive

the faxed signed Form 8453 prior to

transmitting the return to the IRS. The

completed Form 8453, with signatures, must

be mailed by the ERO to the IRS.

Note. Do not mail a copy of an electronically

filed Form 1040, 1040A, or 1040EZ to the

Internal Revenue Service (IRS).

IF the electronic return

was transmitted to:

THEN mail Form 8453 to:

Andover or Kansas City

Submission Processing Center

Austin, Fresno, or Philadelphia 

Submission Processing Center

Internal Revenue Service

Attn: Shipping and Receiving, 0254

Receipt and Control Operations

Andover, MA 05544-0254

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.

Internal Revenue Service

Attn: Shipping and Receiving, 0254

Receipt and Control Branch

Austin, TX 73344-0254

apartment number. If the taxpayer did not

receive a label, print or type the information in

the spaces provided.