Part III

U.S. Nonresident Alien Income Tax Declaration

for Magnetic Media Filing 8453-NR

Department of the Treasury

Internal Revenue Service

For the year January 1–December 31, 1996

© See instructions on back.

Taxpayer’s first name and initial Last name Identifying number

Tax Return Information (Whole dollars only)

1 Total effectively connected income (Form 1040NR, line 23) 1

2 Total tax (Form 1040NR, line 49) 2

3 Total payments (Form 1040NR, line 58) 3

4 Refund (Form 1040NR, line 60a) 4

5 Amount you owe (Form 1040NR, line 62) 5

Direct Deposit of Refund (Optional—See instructions.)

6 Routing number The first two digits of the routing number must

be 01 through 12 or 21 through 32.

7 Account number

Declaration of Taxpayer (Sign only if Part I is completed.)

Under penalties of perjury, I declare that the information I have given my magnetic media return originator (MMRO) and the amounts in Part I above

(or the amounts on the attached listing) agree with the amounts on the corresponding lines of the magnetic media portion of my 1996 Federal

income tax return. To the best of my knowledge and belief, my return is true, correct, and complete. I consent to my MMRO sending my return,

this declaration, and accompanying schedules and statements to the Internal Revenue Service (IRS). I also consent to the IRS sending my MMRO

an acknowledgment of receipt of transmission and an indication of whether or not my return is accepted, and, if rejected, the reason(s) for the

rejection. If the processing of my return or refund is delayed, I authorize the IRS to disclose to my MMRO and/or transmitter the reason(s) for the

delay, or when the refund was sent.

Sign Here Your signature Date

Declaration of Magnetic Media Return Originator (MMRO) and Paid Preparer (See instructions.)

Date Your social security number

Check if selfemployedMMRO’s

MMRO’s signature

Use Only Firm’s name (or

yours if self-employed)

and address

EIN

ZIP code

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 social security no.

Preparer’s

signature Paid

Preparer’s

Use Only

EIN

ZIP code

Cat. No. 13115A Form 8453-NR (1996)

Part I

©

I declare that I have reviewed the above taxpayer’s return and that the entries on Form 8453-NR 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 Procedures for Magnetic Media Filing of U.S. Nonresident Alien Income Tax Returns, Forms

1040NR, for Tax Year 1996. 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 declaration

is based on all information of which I have any knowledge.

Part IV

©

©

Firm’s name (or

yours if self-employed)

and address

Check if © self-employed

©

OMB No. 1545-1274

For Paperwork Reduction Act Notice, see instructions.

Part II

I consent that my refund be directly deposited as designated in Part II, and declare that the information on lines 6 through 8 is correct.

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. Form

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

Check if

also paid

preparer

8 Type of account: Checking Savings

96

9
Form 8453-NR (1996) Page 2

Purpose of Form

Use Form 8453-NR to:

● Authenticate the magnetic media portion of Form 1040NR,

U.S. Nonresident Alien Income Tax Return,

● Send any accompanying paper schedules, statements, and

magnetic media,

● Authorize the magnetic media return originator (MMRO) to

transmit via a third-party transmitter, and

● Confirm the taxpayer’s consent to directly deposit any

overpayment into an account of a U.S. financial institution

located in the United States.

Who Must File

Every nonresident alien filing a 1996 Form 1040NR via magnetic

media must file a signed 1996 Form 8453-NR.

Note: Some financial institutions may not accept direct deposits

into accounts that are payable through another bank or financial

institution, including credit unions. Also, the financial institution

must be a U.S. financial institution located in the United States.

The IRS cannot make a direct deposit to a foreign bank or a

foreign branch of a U.S. bank.

Signature for Multiple-Return Filing

A single signature may be used for a multiple-return filing by a

person authorized to sign each return. If you are filing more than

one return for which only one signature is provided, write “See

attached Multiple-Return Information Listing” in the space

provided for the taxpayer’s name. You must also attach a

Multiple-Return Information Listing according to the instructions

given in the Procedures for Magnetic Media Filing of U.S.

Nonresident Alien Income Tax Returns, Forms 1040NR, for Tax

Year 1996. The information listing must include the name control

for each taxpayer, identifying number, and the information

requested on lines 1 through 5 of Form 8453-NR for each return.

Part III—Declaration of Taxpayer

An income tax return transmitted on magnetic media will not be

considered complete, and therefore filed, unless and until a

Form 8453-NR signed by the taxpayer is received by the IRS.

When To File

Returns filed on magnetic media are due the same dates as

Forms 1040NR filed on paper. The transmitter must send the

signed Form(s) 8453-NR in the same package with the

corresponding tape or diskette.

If the MMRO makes changes to the magnetic media return

after Form 8453-NR has been signed by the taxpayer but before

it is transmitted and either 1 or 2 below applies, the MMRO

must have the taxpayer complete and sign a corrected Form

8453-NR.

Where To File

1. The total effectively connected income on line 1 differs from

the amount on the magnetic media portion of the return by more

than $25, or

Send Form 8453-NR to:

Internal Revenue Service

Philadelphia Service Center

Attention: DP: 115

11601 Roosevelt Blvd.

Philadelphia, PA 19154

2. The total tax on line 2, the refund on line 4, or the amount

owed on line 5 differs from the amount on the magnetic media

portion of the return by more than $7.

Part IV—Declaration of Magnetic Media

Return Originator (MMRO) and Paid

Preparer

Part II—Direct Deposit of Refund

Taxpayers who completed lines 60b–60d on Form 1040NR to

have their refund directly deposited must also complete Form

8453-NR, Part II.

Line 6. The routing number must be nine digits. If it does not

begin with 01 through 12 or 21 through 32, the direct deposit

will be rejected and a check sent.

Line 7. The account number can be up to 17 characters (both

numbers and letters). 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.

Refunds. After the IRS has accepted the return, the refund

should be issued within 21 days. However, some refunds may

be delayed because of compliance reviews to ensure that

returns are accurate.

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 simpler, we would be happy to hear from you. You can

write to the Tax Forms Committee, Western Area Distribution

Center, Rancho Cordova, CA 95743-0001. DO NOT send the

form to this address. Instead, see Where To File below.

A paid preparer must sign Form 8453-NR in the space for Paid

Preparer’s Use Only. But if the paid preparer is also the

MMRO, do not complete the paid preparer’s section. Instead,

check the box labeled “Check if also paid preparer.”

The IRS requires the MMRO’s signature.

All filers must check one of the boxes for line 9.

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.

A check, form, report, or other statement generated by the

financial institution should show the routing number and account

number. For accounts payable through a financial institution

other than the one at which the account is located, the taxpayer

should use a document, such as an account statement or

account identification card, showing the routing number of the

bank or institution where the account is located. A deposit slip

should not be used because it can contain internal routing

numbers. If there is any doubt about the correct routing number,

the taxpayer should contact the financial institution and ask for

the correct routing number for direct deposit (Electronic Funds

Transfers).