Part III

U.S. Nonresident Alien Income Tax Declaration

for Magnetic Media Filing Form 8453-NR

Department of the Treasury

Internal Revenue Service

For the year January 1–December 31, 1992

© See instructions on back.

Taxpayer’s first name and initial Last name Identifying or social security number

Tax Return Information (Whole dollars only)

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

2 Total tax (Form 1040NR, line 50) 2

3 Total payments (Form 1040NR, line 60). If any is from Form(s) 1099, check here © 3

4 Refund (Form 1040NR, line 62) 4

5 5 Amount you owe (Form 1040NR, line 64)

Direct Deposit of Refund (See instructions.)

6 Name of financial institution and, if applicable, branch name

7 Routing transit number (RTN)

The first two numbers of the RTN must

be 01 through 12 or 21 through 32.

8 Depositor account number (DAN)

9 Type of account: Savings Checking

10 Proof of account: Check Other

11 Ownership of account. Find the taxpayer’s filing status and check the box that applies:

● Single or qualifying widow(er) © Self

● Married filing separate return © Self OR Self and Spouse

Declaration of Taxpayer

Under penalties of perjury, I declare that I have compared the information contained on my return with the information I have provided to my magnetic media return originator

(MMRO) and that the amounts described in Part I above (or the amounts on the attached listing) agree with the amounts shown on the corresponding lines of my 1992

Federal income tax return. To the best of my knowledge and belief, my return is true, correct, and complete. I consent that my return, including this declaration and

accompanying schedules and statements, be sent to the Internal Revenue Service (IRS) by my MMRO. If I have elected Direct Deposit, I declare that the information

shown on lines 6 through 11 in Part II above is correct; I consent that my refund be directly deposited as designated in Part II above; and I authorize the IRS to

inform my MMRO and/or the transmitter whether my request for Direct Deposit will be honored. If the processing of my return or refund is delayed, I authorize

the IRS to disclose to my MMRO and/or the transmitter the reason(s) for the delay, or when the refund was sent.

Please

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

E.I. No.

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. Declaration of preparer is based on all information of which the preparer has any knowledge.

Date Preparer’s social security no.

Preparer’s

signature Paid

Preparer’s

Use Only

E.I. No.

ZIP code

Cat. No. 13115A Form 8453-NR (1992)

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. (MMROs who are

only collectors are not responsible for reviewing the taxpayer’s return; however, they must ensure that Form 8453-NR accurately reflects the data on the return.) If Part II is

completed, I declare that I have verified the taxpayer’s proof of account and that this proof of account agrees with the name shown on this declaration. I have obtained the

taxpayer’s signature on Form 8453-NR before submitting this return to the IRS, have provided the taxpayer with a copy of all forms and information to be filed with the IRS,

and have followed all other requirements described in Procedures for Magnetic Media Filing of U.S. Nonresident Alien Income Tax Returns, Forms 1040NR, for Tax Year

1992. 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. Declaration of preparer is based on all information of which the preparer has 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.

Check if

also paid

preparer

Part II
Form 8453-NR (1992) Page 2

Line 10. To be eligible for Direct Deposit, taxpayers must

provide proof of account ownership to their magnetic media

return originator (MMRO). An acceptable proof of account

ownership is a check, form, report, or other statement generated

by the financial institution that has the taxpayer’s name, RTN of

the financial institution, and the depositor account number

preprinted on it.

Purpose of Form

Use Form 8453-NR to:

● Authenticate the magnetic media portion of Form 1040NR,

U.S. Nonresident Alien Income Tax Return,

● Serve as a transmittal for any accompanying paper schedules,

statements, and magnetic media,

For accounts that are payable through a financial institution

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

must provide a document such as an account statement or

account identification card showing the RTN of the bank or

institution where the account is located. A deposit slip should

not be used to verify the RTN and account number because it

can contain internal routing numbers that are not part of the

RTN.

● Authorize the magnetic media return originator to transmit via

a third-party transmitter, and

● Provide 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

If there is any doubt about the correct RTN, the taxpayer

should contact the financial institution and ask for the correct

RTN for Direct Deposit (Electronic Funds Transfers).

Every nonresident alien filing a 1992 Form 1040NR via magnetic

media must file a signed 1992 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.

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 1992. The information listing must include the name control

for each taxpayer, taxpayer identification number (TIN), and the

information requested on lines 1 through 5 of Form 8453-NR for

each return.

Line 11. The account designated to receive the Direct Deposit

must be in the taxpayer’s name. If the taxpayer’s filing status on

Form 1040NR is married filing separately, the account can be in

the taxpayer’s name, or it can be a joint account in both

spouses’ names.

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.

The taxpayer’s signature is required for all returns. If Part II is

completed, this signature allows the IRS to advise the MMRO

and/or the transmitter if a Direct Deposit election will not be

honored. It also allows the IRS to disclose to the MMRO and/or

the transmitter the reason(s) for a delay in processing the return

or refund.

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, the MMRO must have the taxpayer complete

and sign a corrected Form 8453-NR if either of the following

applies:

Where To File

● 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

● 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 $5.

Part IV—Declaration of Magnetic Media

Return Originator (MMRO) and Paid

Preparer

Part II—Direct Deposit of Refund

Taxpayers can elect to have their refund directly deposited into a

financial institution by completing Part II.

The MMRO’s signature is required by the IRS.

Note: 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.

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

Paid Preparer’s Use Only. Only handwritten signatures are

acceptable. However, 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.”

Line 7. The routing transit number (RTN) must contain nine

digits. If the RTN does not begin with 01 through 12, or 21

through 32, the Direct Deposit request will be rejected.

Line 8. The depositor account number (DAN) can contain up to

17 alphanumeric characters. 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 3 weeks. If the taxpayer elects to have

the refund directly deposited into a savings or checking account,

the taxpayer’s account may be credited even sooner.

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 more simple, we would be happy to hear from you. You

can write to both the Internal Revenue Service, Washington,

DC 20224, Attention: IRS Reports Clearance Officer, T:FP; and

the Office of Management and Budget, Paperwork Reduction

Project (1545-1274), Washington, DC 20503. DO NOT send this

form to either of these offices. Instead, see Where To File

below.