Declaration Control Number (DCN)

0 7 0 – – –

U.S. Individual Income Tax Declaration OMB No. 1545-1397 8453-OL for On-Line Filing

Form

Department of the Treasury

Internal Revenue Service

For the year January 1–December 31, 1996

© See instructions on back.

Your first name and initial Last name Your social security number L

A

B

E

L

H

E

R

E

Use the

IRS label.

Otherwise,

please

print or

type.

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

Home address (number and street). If a P.O. box, see instructions. Apt. no. Telephone number (optional)

( )

City, town or post office, state, and ZIP code For Paperwork Reduction Act

Notice, see instructions.

Tax Return Information (Whole dollars only)

1 Total income (Form 1040, line 22; Form 1040A, line 14; Form 1040EZ, line 4) 1

2 Total tax (Form 1040, line 51; Form 1040A, line 28; Form 1040EZ, line 10) 2

3 Federal income tax withheld (Form 1040, line 52; Form 1040A, line 29a; Form 1040EZ, line 7). 3

4 Refund (Form 1040, line 60a; Form 1040A, line 31a; Form 1040EZ, line 11a) 4

5 Amount you owe (Form 1040, line 62; Form 1040A, line 33; Form 1040EZ, line 12). See instructions 5

Declaration of Taxpayer

Attach Copy B of

your Forms W-2, W-2G,

and 1099-R here.

If I have completed Part II above, 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 joint return, this is an irrevocable appointment

of the other spouse as an agent to receive the refund.

Sign

Here © Your signature Date

Part I

Cat. No. 15907C Form 8453-OL (1996)

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

96

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

Part II

8 Type of account: Checking Savings

Part III

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.

Under penalties of perjury, I declare that the information I have given my on-line filing company and the amounts

in Part I above agree with the amounts on the corresponding lines of the electronic 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 that

the electronic portion of my return be sent to the IRS by my on-line filing company.

© Spouse’s signature. If a joint return, BOTH must sign. Date
Form 8453-OL (1996) Page 2

Paperwork Reduction Act

Notice

P.O. Box. Enter your P.O. box number

only if the post office does not deliver mail

to your home.

Note: The address must match the address

shown on your electronically filed return.

Part I—Tax Return Information

Part III—Declaration of Taxpayer

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

When and Where To File on this page.

Line 5. Do not attach your check or

money order to Form 8453-OL. Instead,

mail it by April 15, 1997, with Form 1040-V

to the IRS at the applicable address shown

in the chart below. If you do not have a

Form 1040-V, you may be able to get it

from your on-line filing company. You can

also see your tax return instruction booklet

for other ways to get forms, including

using the IRS’s Internet Web Site

(http://www.irs.ustreas.gov).

Your electronically transmitted return will

not be considered complete, and therefore

filed, unless and until the IRS receives your

signed Form 8453-OL. If a joint return,

your spouse must also sign.

Line Instructions

Declaration Control Number (DCN). The

DCN is a 14-digit number assigned to your

return by your on-line filing company. It is

included in your acknowledgment

message. Clearly type or print the DCN in

the top left corner of Form 8453-OL. The

first two digits are always "00". The next

six digits are the electronic filer

identification number (EFIN) assigned to

your on-line filing company by the IRS. The

next five digits are the batch number and

serial number assigned to your return by

your on-line filing company. The "7"

represents the year the return is filed

(1997).

Refunds. Your refund should be issued

within 21 days after the IRS has accepted

your return. However, some refunds may

be delayed because of compliance reviews

to ensure that the returns are accurate.

Refund information is available on

Tele-Tax. See your tax return instruction

booklet for the phone number.

Example. The EFIN is 509325. The

batch number is 000. The serial number is

56. The DCN is 00-509325-00056-7.

Name, Address, and Social Security

Number (SSN). If you received a peel-off

label from the IRS, place it in the name

area. Cross out any errors and print the

correct information. Add any missing items,

such as your apartment number. If you did

not receive a label, print or type the

information in the spaces provided. Make

sure your SSN is clear and correct. If a

joint return, be sure the names and SSNs

are listed in the same order.

When and Where To File

You must mail this form to the IRS on the

next working day after you have received

acknowledgment from your on-line filing

company that the IRS has accepted your

electronically filed return. The address

should be included in your

acknowledgment message. If not, mail

Form 8453-OL to the IRS at the applicable

address shown in the chart below.

Purpose of Form

Use Form 8453-OL to authenticate the

electronic portion of your 1996 Form 1040,

1040A, or 1040EZ, and send any

accompanying paper schedules and

statements.

Who Must File

If you are filing a 1996 Form 1040, 1040A,

or 1040EZ through an on-line filing

company, you must file a signed 1996

Form 8453-OL with the IRS. If you do not,

you will not have filed a valid return for

1996, and we may not allow you to file

electronically next year.

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.

The time needed to complete and file

this form will vary depending on individual

circumstances. The estimated average time

is 15 minutes.

Part II—Direct Deposit of Refund

Line 6.—The routing number must be nine

digits.

Line 7.—The account number can be up

to 17 characters (both numbers and

letters). Include hyphens but omit spaces

and special symbols.

If you live in: Mail Form 8453-OL

to this address:

Connecticut, Delaware, District of Columbia, Maine,

Maryland, Massachusetts, New Hampshire, New Jersey,

New York, Pennsylvania, Rhode Island, Vermont, Virginia,

and all APO and FPO addresses (except Asian/Pacific)

Illinois, Iowa, Kansas, Minnesota, Missouri, New Mexico,

Oklahoma, Texas, Wisconsin

Florida, Indiana, Kentucky, Michigan, Ohio,

South Carolina, West Virginia

Alabama, Arkansas, Georgia, Louisiana, Mississippi,

North Carolina, Tennessee

Alaska, Arizona, California, Colorado, Hawaii, Idaho,

Montana, Nebraska, Nevada, North Dakota, Oregon,

South Dakota, Utah, Washington, Wyoming, and all

Asian/Pacific APO and FPO addresses

Mail Form 1040-V with your

payment to this address:

Receipt and Control Branch

Shipping and Receiving

310 Lowell Street

Andover, MA 05501

Receipt and Control Branch

Shipping and Receiving

P.O. Box 1231

Austin, TX 78767-1231

Cincinnati, OH 45999

P.O. Box 1898

Attn: 8453-OL

Memphis, TN 38101

Stop 6052

1160 West 1200 South

Ogden, UT 84201

P.O. Box 371361

Pittsburgh, PA 15250-7361

P.O. Box 970016

St. Louis, MO 63197-0016

P.O. Box 6223

Chicago, IL 60680-6223

P.O. Box 7704

San Francisco, CA 94120-7704

P.O. Box 1214

Charlotte, NC 28101-1214

You must complete Part II if you elected to

have your refund directly deposited by

completing Form 1040, lines 60b-60d (lines

31b-31d on Form 1040A, lines 11b-11d on

Form 1040EZ). Enter the same information

in Part II that you entered on those lines.

See your tax return instruction booklet for

more details about direct deposit.

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.