Form 8453-EX
(Rev. December 2011)
Department of the Treasury
Internal Revenue Service
Excise Tax Declaration for an IRS e-file Return
For the period beginning , 20 , and ending , 20
.
For use with Forms 720, 2290, and 8849.
File electronically. Do not file paper copies.
See instructions.
OMB No. 1545-2082
Name (as shown on Form 720, 2290, or 8849) Taxpayer identification number
Part I
Type of Return and Return Information (Whole dollars only)
Check the box for the return for which you are using this Form 8453-EX and enter the applicable amount from the return. If you check
the box on lines 1a, 2a, or 3a, below, and the amount on that line for the return for which you are filing this form was blank, leave lines
1b, 1c, 2b, or 3b, whichever is applicable, blank (do not enter -0-). However, if you entered -0- on the return, enter -0- on the
applicable line below. Do not complete more than one line in Part I.
1a Form 720 check here
b Balance due, if any (Form 720, Part III, line 10) . . . . .
1b
c Overpayment, if any (Form 720, Part III, line 11) . . . . 1c
2a Form 2290 check here
b Balance due (Form 2290, line 6) . . . . . . . . .
2b
3a Form 8849 check here
b Total refund (from Schedules 1, 2, 3, 5, 6, or 8) . . . .
3b
Caution. For line 3b, Schedules 2, 3, 5, and 8 cannot be combined with any other schedules. File a separate Form 8453-EX for each
schedule.
Part II
Declaration of Taxpayer (see instructions)
4a I am requesting a refund on Form 720 or Form 8849.
b
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 federal taxes owed for the
return indicated on lines 1a or 2a, 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 two 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.
Under penalties of perjury, I declare that the information I have given my electronic return originator (ERO), transmitter, and/or intermediate service provider (ISP) and the
amounts in Part I above agree with the amounts on the corresponding return. To the best of my knowledge and belief, the return is true, correct, and complete. I consent to
my ERO, transmitter, and/or ISP sending the return, this declaration, and accompanying schedules and statements to the IRS. I also consent to the IRS sending my ERO,
transmitter, and/or ISP an acknowledgment of receipt of transmission and an indication of whether or not the return is accepted and, if rejected, the reason(s) for the
rejection. If the processing of the return or refund is delayed, I authorize the IRS to disclose to my ERO, transmitter, and/or ISP the reason(s) for the delay, when the refund
was sent.
Sign
Here
Taxpayer’s signature
Date
Part III
Declaration of Electronic Return Originator (ERO) and Paid Preparer (see instructions)
I declare that I have reviewed the return indicated above and that the entries on Form 8453-EX are complete and correct to the best of my knowledge. If I am only a
collector, I am not responsible for reviewing the return and only declare that this form accurately reflects the data on the return. The taxpayer will have signed this form
before I submit the return. I will give the taxpayer a copy of all forms and information to be filed with the IRS, and have followed all other requirements in Pub. 3112, IRS
e-file Application and Participation, and Pub. 4163, Modernized e-File (MeF) Information for Authorized IRS e-file Providers for Business Returns. If I am also the paid
preparer, under penalties of perjury I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and
belief, it is true, correct, and complete. This paid preparer declaration is based on all information of which I have any knowledge.
ERO’s
Use
Only
ERO’s
signature
Date Check if
also paid
preparer
Check if self-
employed
ERO’s SSN or PTIN
Firm’s name (or yours
if self-employed),
address, and ZIP code
EIN
Phone no.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is
true, correct, and complete. This declaration is based on all information of which I have any knowledge.
Paid
Preparer
Use Only
Print/Type preparer’s name Preparer’s signature Date
Check if
self-employed
PTIN
Firm’s name
Firm’s address
Firm's EIN
Phone no.
For Privacy Act and Paperwork Reduction Act Notice, see instructions.
Cat. No. 49631B
Form 8453-EX (Rev. 12-2011)
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Form 8453-EX (Rev. 12-2011)
Page 2
General Instructions
Note. Instead of filing Form 8453-EX, a taxpayer filing an excise tax
return or request for refund through an electronic return originator
(ERO) can sign the return or request for refund using a personal
identification number (PIN). For details, see Form 8879-EX, IRS e-
file Signature Authorization for Forms 720, 2290, and 8849.
Purpose of Form
Use Form 8453-EX to:
• Authenticate electronic Forms 720, 2290, or 8849;
• Authorize the ERO, if any, to transmit via a third-party transmitter;
• Authorize the intermediate service provider (ISP) to transmit via a
third-party transmitter if you are filing online (not using an ERO); and
• Provide the taxpayer’s consent to authorize an electronic funds
withdrawal for payment of federal taxes owed.
Who Must File
If you are filing Forms 720, 2290, or 8849 through an ISP and/or
transmitter and you are not using an ERO, you must file Form
8453-EX with your electronically filed return. An ERO can use either
Form 8453-EX or Form 8879-EX to obtain authorization to file Forms
720, 2290, and 8849.
When and Where To File
File Form 8453-EX with the taxpayer’s electronically filed return.
Use a scanner to create a Portable Document Format (PDF) file of
the completed form. Your tax preparation software will allow you to
transmit this PDF with the return.
Specific Instructions
Name. Print or type the taxpayer’s name as shown on Forms 720,
2290, or 8849.
Taxpayer identification number. Enter the taxpayer’s
identification number as shown on Forms 720, 2290, or 8849.
Part II. Declaration of Taxpayer
If the taxpayer has a balance due on lines 1b or 2b and the
taxpayer did not check box 4b, the taxpayer must use the
Electronic Federal Tax Payment System (EFTPS) to pay the tax. For
more information on deposits, see the instructions for the tax form
the taxpayer is filing.
If the taxpayer checks box 4b, the taxpayer must ensure that the
following information relating to the financial institution account is
provided in the tax preparation software.
• Routing number and account number.
• Type of account (checking or savings).
• Debit amount.
• Debit date (date the taxpayer wants the debit to occur).
An electronically transmitted return will not be considered
complete, and therefore filed, unless either:
• Form 8453-EX is signed by the taxpayer, scanned into a PDF file,
and transmitted with the return; or
• The return is filed through an ERO and Form 8879-EX is used to
select a PIN that is used to electronically sign the return.
The taxpayer’s signature allows the IRS to disclose to the ERO,
transmitter, and/or ISP:
• An acknowledgement that the IRS has accepted the electronically
filed return, and
• The reason(s) for any delay in processing the return or refund.
Part III. Declaration of Electronic Return
Originator (ERO) and Paid Preparer
Note. If the return is filed online through an ISP and/or transmitter
(not using an ERO), do not complete Part III.
If the taxpayer’s return is filed through an ERO, the IRS requires
the ERO’s signature. A paid preparer, if any, must sign Form
8453-EX in the space for Paid Preparer Use Only. But if the paid
preparer is also the ERO, do not complete the paid preparer
section. Instead, check the box labeled “Check if also paid
preparer.”
Refunds. After the IRS has accepted the return, the refund should
be issued within 3 weeks. However, some refunds may be delayed
to ensure that returns are accurate.
Use of PTIN
Paid preparers. Anyone who is paid to prepare the taxpayer's
return must enter their preparer tax identification number (PTIN) in
Part III. The PTIN entered must have been issued after September
27, 2010. For information on applying for and receiving a PTIN, see
Form W-12, IRS Paid Preparer Tax Identification Number (PTIN)
Application and Renewal, or visit www.irs.gov/ptin.
EROs who are not paid preparers. Only EROs who are not also
the paid preparer of the return have the option to enter their PTIN or
their social security number in the “ERO's Use Only” section of Part
III. If the PTIN is entered, it must have been issued after September
27, 2010. For information on applying for and receiving a PTIN, see
Form W-12, or visit www.irs.gov/ptin.
Privacy Act and 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. Section 6109
requires EROs to provide their identifying numbers on the return.
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:
Recordkeeping . . . . . . . . . . . 2 hrs., 23 min.
Learning about the law or the form . . . . . . . 12 min.
Preparing, copying, assembling, and sending
the form to the IRS . . . . . . . . . . . . . 14 min.
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:M:S, 1111 Constitution Ave. NW, IR-6526,
Washington, DC 20224. Do not send Form 8453-EX to this address.
Instead, see When and Where To File on this page.
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