: 8453-NR U.S. Nonresident Alien Income Tax Declaration

for Magnetic Media Filing 1990
Department of the Treasury For the year January 1-December 31, 1990
internal Revenue Service > 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 Totaltax(Form 1040NR, line51) . . 2 1... Le oe bE
3 Total payments (Form 1040NR, line 62). If any is from Form(s) 1099, check here. . nl O 3

4 Refund (Form 1040NR, line 64) .

5 Amount you owe (Form 1040NR, line 66)... . |. - ee 5
Direct Deposit of Refund (See instructions on back.)

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 depositor account : C7 savings (1 checking
10 Proof of account: O Check oO Other
11 Ownership of deposit account. Find the taxpayer’s filing status and check the box that applies:
© Single or qualifying widower). . ... >» OC) Self
© Married filing separate return . 2...» [sett or C1 setfand Spouse

j Part (U1 Declaration of Taxpayer

Under penalties of perjury, | declare that | have compared the information contained on my return with the information | have provided to my magnetic media return originator and
that the amounts described in Part | above (or the amounts on the attached listing) agree with the amounts shown on the corresponding lines of my 1990 Federal income tax
return, To the best of my knowiedge and belief, my return is true, correct. and complete. | consent that my return including ths declaration and accompanying schedules and
statements, be sent to the Internal Revenue Service by my magnetic media return originator. If | have elected Direct Deposit, | declare that the information shown on lines 6
through 11 in Part Il above Is correct; | consent that my refund be directly deposited as designated in Part Il above; and | authorize the Internal Revenue Service to
inform my magnetic media return originator and/or the transmitter whether my request for Direct Deposit will be honored.

Please

Sign
-Here Your signature Date

GEMM Declaration of Magnetic Media Return Originator (MMRO) and Paid Preparer

| declare that | 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 ll is completed,
I declare that | have verified the taxpayer's proof of account and that this proof of account agrees with the name shown on this deciaration. | have obtained the taxpayer's signature

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 followee all other requirements
described in Procedures for Magnetic Media Filing of U.S, Nonresident Alien Income Tax Returns, Forms 1040NR, for Tax Year 1990.
Date Your social security number

MMRO's Check if . .
MMRO's senate settempioyed [_]

Firm's name (or EN
Use Only sorrefSatePbioyecy » 2

and address 2IP code

Under penaities of perjury, | declare that | 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 compiete. Declaration of preparer 1s based on all information of which preparer has any knowledge.

o Date | Preparer's social security no.
|
Paid Preparers Check if . :
1. Sgnature | self-employed Oo
Preparer’s Frnvsname (or » EJ. No
yours if self-employed!
Use Only La sdurecs ZIP code

Cat. No. 131158 Form 8453-NR (1990)


Form 8453-NR (1990)

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;

e Serve as a transmittal for any accompanying paper schedules,
statements, and magnetic media;

e Authorize the magnetic media return originator to transmit via a
third-party transmitter; and

® Provide the taxpayer’s consent to directly deposit any
overpayment in an account of a U.S. financial institution located in
the United States.

Who Must File

Every nonresident alien filing a 1990 Form 1O40NR via magnetic
media must file a signed 1990 Form 8453-NR.

Signature for Muitiple-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 104ONR, for Tax
Year 1990. The information listing must include the name control
for each taxpayer, taxpayer identification number (TIN), and the
information shown on lines 1 through 5 on the front for each
return.

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

Where To File
Send Form 8453-NR to:

Internal Revenue Service
Philadelphia Service Center
Attention: DP: 115

11601 Roosevelt Bivd.
Philadelphia, PA 19154

Part !l.—Direct Deposit of Refund

Taxpayers can elect to have their refund directly deposited into a
financial institution by completing Part tl.

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.

Line 7. The routing transit number (RTN) must contain 9 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.

Line 10. To be eligible for Direct Deposit, taxpayers must provide
proof of account ownership to their magnetic media return
originator. 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.

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.

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).

Note: Some financial institutions may not accept Direct Deposits
into accounts that are payable through another bank or financial
institution, including credit unions.

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 a joint account in both spouses’ names.

Part IIl.—Dectaration 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 Il is
completed, this signature allows the IRS to advise the magnetic
media return originator (MMRO) and/or the transmitter if a Direct
Deposit election will not be honored.

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:

@ The total effectively connected income (Form 8453-NR, line 1)
differs from the amount on the magnetic media portion of the return
by more than $25, or

@ The total tax (Form 8453-NR, line 2), the refund (Form 8453-NR,
line 4), or the amount owed (Form 8453-NR, 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

The MMRO'’s signature is required by the IRS.

A paid preparer must also sign Form 8453-NR in the space for
Paid Preparer’s Use Only, even if the paid preparer is also the
MMRO. Only handwritten signatures are acceptable
Refunds. /f the taxpayer elects Direct Deposit, the taxpayer can
usually expect the refund within 2-3 weeks after the IRS
acknowledges receipt of the return. If the taxpayer does not elect
Direct Deposit, the refund should be received in about 3 weeks.

US. GOVERNMENT PRINTING OFFICE: 1991 0-865 264