I authorize to enter my PIN as my signature

on the organization’s tax year 2004 electronically filed return.

Form 8879-EO

Department of the Treasury

Internal Revenue Service

IRS e-file Signature Authorization

for an Exempt Organization OMB No. 1545-1878

Return ID (20-digit number)

Name of exempt organization

Name and title of officer

Employer identification number

Type of Return and Return Information (Whole Dollars Only)



Part I

Form 8879-EO (2004)

 Do not send to the IRS. Keep for your records.

 See instructions.

Declaration and Signature Authorization of Officer

Under penalties of perjury, I declare that I am an officer of the above organization and that I have examined a copy of the organization’s

2004 electronic return and accompanying schedules and statements and to the best of my knowledge and belief, they are true,

correct, and complete. I further declare that the amount in Part I above is the amount shown on the copy of the organization’s

electronic return. I consent to allow my intermediate service provider, transmitter, or electronic return originator (ERO) to send the

organization’s return to the IRS and to receive from the IRS (a) an acknowledgement 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. If applicable, I authorize the U.S. Treasury and its designated Financial Agent to initiate an electronic funds withdrawal

(direct debit) entry to the financial institution account indicated in the tax preparation software for payment of the organization’s

Federal taxes owed on this return, and the financial institution to debit the entry to this account. 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. I have selected a personal identification number

(PIN) as my signature for the organization’s electronic return and, if applicable, the organization’s consent to electronic funds

withdrawal.

Part II

ERO’s EFIN/PIN. Enter your six-digit EFIN followed by your five-digit self-selected PIN.

ERO Must Retain This Form—See Instructions

Do Not Submit This Form To the IRS Unless Requested To Do So

For Paperwork Reduction Act Notice, see back of form. Cat. No. 37189W

ERO’s signature  Date 

Certification and Authentication

do not enter all zeros

I certify that the above numeric entry is my PIN, which is my signature on the 2004 electronically filed return for the organization

indicated above. I confirm that I am submitting this return in accordance with the requirements of Pub. 4206, Modernized e-file

Information for Authorized IRS e-file Providers for Exempt Organization Filings.

Part III

Officer’s PIN: check one box only

As an officer of the organization, I will enter my PIN as my signature on the organization’s tax year 2004 electronically

filed return.

Officer’s signature  Date 

ERO firm name do not enter all zeros

For calendar year 2004, or fiscal year beginning , 2004, and ending , 20 

Check the box for the return for which you are using this Form 8879-EO and enter the applicable amount from the return if

any. If you check the box on line 1a, 2a, 3a, 4a or 5a below and the amount on that line for the return for which you are

filing this form was blank, then leave line 1b, 2b, 3b, 4b, or 5b, whichever is applicable, blank (i.e., do not enter -0-). But, if

you entered -0- on the return, then enter -0- on the applicable line below. Do not complete more than 1 line in Part I.

1a Form 990 check here  b Total revenue, if any (Form 990, line 12) 1b

2a Form 990-EZ check here  b Total revenue, if any (Form 990-EZ, line 9) 2b

3a Form 1120-POL check here  b Total tax (Form 1120-POL, line 22) 3b

2004

4a

5a

Form 990-PF check here 

Form 8868 check here 

b Tax Based on Investment Income (Form 990-PF, Part VI, line 5)

b Balance Due (Form 8868, line 3c)

4b

5b
Form 8879-EO (2004) Page 2

Purpose of Form

An organization officer and an electronic

return originator (ERO) use Form

8879-EO when the organization officer

wants to use a personal identification

number (PIN) to electronically sign an

organization’s electronic return and, if

applicable, consent to electronic funds

withdrawal. In the case of Form 990-PF,

Form 1120-POL, and Form 8868 with

payment, Form 8879-EO is used to

consent to electronic funds withdrawal.

An organization officer who does not use

Form 8879-EO must use Form 8453-EO,

Exempt Organization Declaration and

Signature for Electronic Filing. For more

information, see the instructions for

Form 8453-EO.

ERO Responsibilities

Officer’s Responsibilities

The officer of an organization has the

following responsibilities:

Important Notes for EROs

● Do not send Form 8879-EO to the IRS

unless requested to do so. Retain the

completed Form 8879-EO for 3 years

from the return due date or IRS received

date, whichever is later.

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.

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. The rules governing the

confidentiality of the Form 990, Form

990-EZ and Form 990-PF, are covered

in Code section 6104. All other tax

returns (Form 1120-POL) and return

information are generally 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:

If you have comments concerning the

accuracy of these time estimates or

suggestions for making this form

simpler, we would be happy to hear

from you. You can write to the Internal

Revenue Service, Tax Products

Coordinating Committee,

SE:W:CAR:MP:T:T:SP, 1111 Constitution

Ave. NW, IR 6406, Washington, DC

20224. Do not send the form to this

address. Instead, keep it for your

records.

Learning about the law

or the form 12 min.

Preparing the form 16 min.

Form 8879-EO must be

completed and signed before

submission of the electronic CAUTION return.

!

Recordkeeping 3 hr., 49 min.

● Enter the name and employer

identification number of the organization

at the top of the form;

● Complete Part I by checking the box

for the type of return being filed and

using the amount, if any, from the

organization’s 2004 return;

● Enter on the authorization line in Part

II the ERO firm name (not the name of

the individual preparing the return) if the

ERO is authorized to enter the officer’s

PIN;

The ERO will:

● Give the officer Form 8879-EO for

completion and review. This can be

done by hand delivery, U.S. mail, private

delivery service, email, fax, or Internet

website; and

● Complete Part III including a signature

and date.

● Verify the accuracy of the

organization’s prepared return;

● Verify the type of return being filed in

Part I;

● Check the appropriate box in Part II to

either authorize the ERO to enter the

officer’s PIN or to choose to enter it in

person;

● Indicate or verify his or her self-select

PIN when authorizing the ERO to enter it

(the PIN must be five numbers other

than all zeros);

● Sign and date Form 8879-EO; and

● Return the completed Form 8879-EO

to the ERO by hand delivery, U.S. mail,

private delivery service, or fax.

The ERO must retain Form 8879-EO.

Do not send this form to the IRS.

● Enter the organization officer’s PIN on

the input screen only if the organization

officer has authorized you to do so.

● Provide the officer with a copy of the

signed Form 8879-EO upon request.

● Provide the officer with a corrected

copy of the Form 8879-EO if changes

are made to the return (for example,

based on the officer’s review).

● See Pub. 4206, Modernized e-file

Information for Authorized e-file

Providers for Exempt Organization

Filings, for more information.