Declaration Control Number (DCN)

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8453 U.S. Individual Income Tax Declaration OMB No. 1545-0936
Form sn ENN,

for Electronic Filing
Department of the Treasury al
Internal Revenue Service For the year January 1-December 31, 1988
Use IRS Your first name and initia! (if joint return, also give spouse's name and initial) Last name ~) Your social security number
label. H i
Otherwise, Present home address (number, street, and apt. no.or rural route). (I you have a P.O. Box, see instructions on back.)| — Spouse's social security number
please | : i
print or City, town or post office, state, and ZIP code Telephone number (optional)
type.

¢ )

If the taxpayer's name changed during the past 3 years due to marriage, divorce, etc., and he or she filed a Federal income tax return using
the former name, print the former name(s) in the space provided below.

First name and inttial Last name

Tax Return Information (Whole dollars only)

1 Total income (Form 1040, line 23; Form 1040A, line 11; Form 1040EZ, line 3) .
2 Total tax (Form 1040, line 53; Form 1040A, line 22; Form 1040EZ, line 9)

3 Federal income tax withheld. (Enter from Forms W-2, W-2G, and W-2P only.)

J Joo |r |

4 Refund (Form 1040, line 63; Form 1040A, line 25; Form 1040EZ, line 10) . .
Direct Deposit of Refund (See the instructions on the back of this form.)

5 Name of financial institution and, if applicable, branch

6 Routing transit number (RTN)

7 Depositor account number (DAN)

8 Type of depositor account : | Savings OR O Checking

W-2G, and W-2P here.

9 Source code: [] check or C1 other

Attach Copy B of your Forms W-2,

10 Indicate owner of depositor account (check one): __L] Sel CJ Husband __C] wite oR _L] Husband and Wife
iclaaiig Declaration of Taxpayer

Under penalties of perjury, | declare that the amounts described in Part | above agree with the amounts shown on the corresponding lines
of my 1988 Federal income tax return given to me by my tax return preparer/transmitter, and that | have also compared the information
contained on my return with the information | provided to my preparer/transmitter. To the best of my knowledge and belief, my return and,
if applicable, the account information shown on lines 5 through 10 in Part II above are 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 tax return
transmitter. If applicable, | consent that my refund be directly deposited as designated in Part I! above and authorize the Internal Revenue
Service to inform my preparer/transmitter whether my request for Direct Deposit will be honored. If joint return and the refund is to be
directly deposited, this is an irrevocable appointment of the other spouse as an agent to receive the refund.

Please

Sign
Here Your signature Date ‘Spouse’s signature (if joint return, BOTH must sign)

Declaration of Preparer/Transmitter (If the transmitter did not prepare the tax return, check here. > [_] )

I declare that the above taxpayer’s return is based on all information of which | have knowledge and, if applicable, that | have verified that
the taxpayer’s name shown on this declaration agrees with the name that appears on the proof of account. A copy of all forms and
information to be filed with the Internal Revenue Service has been provided to the taxpayer.

Paid Date Your social security number
Preparer’s/ Sons sare
signature self-employed
Transmitter’s Firm's name (ory » E.1.No
urs if selt-employe
Use Only Sndaddress ZIP code

For Paperwork Reduction Act Notice, see back of form. Form 8453 (1988)


Form 8453 (1988) Page 2

Paperwork Reduction Act Notice

We ask for this information to carry out the Internal Revenue laws of the United States. We need it to ensure that taxpayers are complying
with these laws and to allow us to figure and collect the right amount of tax. You are required to give us this information.
The time needed to complete and file this form will vary depending on individual circumstances. The estimated average time is:

Recordkeeping . . . - + +. + 20 minutes
Learning about the law or the form . . 3minutes
Copying, assembling, and sending

the form to IRS. . . . . 17 minutes

If you have comments concerning the z accuracy of these time estimates or suggestions for making this form more simple, we would be
happy to hear from you. You can write to the Internal Revenue Service, Washington, DC 20224, Attention: IRS Reports Clearance Officer,
TR:FP; or the Office of Management and Budget, Paperwork Reduction Project, Washington, DC 20503.

Declaration Control Number (DCN)

The DCN is a 14-digit number assigned to each taxpayer account. The preparer should enter the electronic filer identification number,
the appropriate sequential number, and the appropriate serial number in the boxes in the upper right corner of the form as follows:

4-8 Electronic filer identification number (EFIN) assigned by IRS
10-13 Sequential number assigned to the return by the electronic filer
14-15 Serial number (00 through 99) assigned to the return by the electronic filer

Example.— The electronic filer identification number is 12345. The sequential number is 6789. The serial number is 10. The DCN to be
entered in the boxes should be shown as 00-12345-678910-9.

Name, Address, and Social Security Number

If the taxpayer received a mailing label from us, place the label in the name area. Mark through any errors on the label and print the correct
information on the label.

If the taxpayer did not receive a label, print or type the taxpayer's name, address, and social security number in the spaces provided on
the form.

P.O. Box.—If the post office does not deliver mail to the taxpayer’s street address and the taxpayer has a P.O. box, enter the P.O. box
number on the line for the present home address instead of the street address.

Name Change.—!f the taxpayer's name changed during the past 3 years because of marriage, divorce, etc., and he or she filed a Federal
income tax return using the former name, print the former name(s) in the space provided on the form.

Part Il.—Direct Deposit of Refund
Complete lines 5 through 10 ONLY if the taxpayer elects to have the refund directly deposited to his or her account in a financial institution.
Line 6.—Enter NINE digits. If the routing transit number (RTN) has fewer than nine digits, the account is ineligible for Direct Deposit.

Line 7.—Enter a maximum of 17 characters. If fewer than 17 characters left, justify the depositor account number (DAN) with trailing
blanks. Include hyphens, but omit spaces and special symbols. This field is alphanumeric.