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Declaration Of Electronic Filing IT-8453OL - Indiana
| Declaration Of Electronic Filing Form. This is a Indiana form and can be used in Electronic Filing Department Of Revenue Statewide . |
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State Form 46201 (R11 / 12-11) IT-8453OL Form DECLARATION OF ELECTRONIC FILING For the tax year January 1 - December 31, 2011 DCN Submission ID Indiana Individual Income Tax Do Not Mail This Form First Name(s) and Middle Initial(s) Spouse's First Name(s) and Middle Initial(s) City Last Name Spouse's Last Name Your Social Security Number Street Address State Zip Code Spouse's Social Security Number Daytime Telephone Number Part I Tax Return Information (See Instructions on Next Page) 1. 2. 3. 4. 5. 6. 7. 8. 1. Federal Adjusted Gross Income .................................................................................. 2. Indiana taxable income ............................................................................................... 3. Total Indiana tax .......................................................................................................... 4. Total state tax withheld ............................................................................................... 5. Total county tax withheld ............................................................................................. 6. Total Indiana tax credits............................................................................................... 7. Refund ........................................................................................................................ 8. Amount you owe ......................................................................................................... t o N o il Da M Part II Direct Deposit W-2 Forms Here 9. Routing number 10. Account number 11. Type of account: Note: The first two digits of the routing number must be 01 - 12 or 21 - 32. Checking Savings Hoosier Works MC Do Not Mail This Form My request for direct deposit of my refund includes my authorization for the Indiana Department of Revenue to furnish my financial institution with my routing number, account number, account type, and social security number to insure my refund is properly deposited. Attach Part III Declaration of Taxpayer If I have filed a balance due return, I understand that if the IDOR 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. Under penalties of perjury, I declare that the amounts in Part I above agree with the amounts on the corresponding lines of the electronic portion of my 2011 income tax return. To the best of my knowledge and belief, my return is true, correct and complete. I consent to allow my transmitter to send my return, this declaration, and accompanying schedules and statements to the IDOR. I also consent to the IDOR sending an acknowledgement of receipt of transmission and an indication of whether or not my return is accepted, and, if rejected, the reason(s) for the rejection. Please sign here _________________________ Taxpayer's Signature ____________ Date __________________________ Spouse's Signature ___________ Date I N D I A N A American LegalNet, Inc. www.FormsWorkFlow.com IT-8453OL Purpose of this form This form is to be completed and signed by the taxpayer before their return can be filed electronically through the Federal/ State On-Line Filing Program. The On-Line Software will: 1. Enter the Document Control Number (DCN) assigned to the electronic tax return in the field provided at the top of the form. 2. Fill in the taxpayer's (and spouse's if filing a joint return) name, address, social security number, and daytime telephone number where indicated at the top of the form. 3. Complete Part I, using the amounts from the taxpayer's Indiana individual income tax return. 4. Complete Part II, if the taxpayer elects to have their refund direct deposited into their financial institution savings or checking account or deposited into their Hoosier Works Card. The Taxpayer will: 1. Complete Part III, with their signature and date. 2. Mail nothing into the Indiana Department of Revenue, unless requested by the department. 3. Keep and maintain the IT-8453OL for three (3) years from December 31st of the year the return was signed. IT-8453OL Part I Instructions Line 1: Federal Adjusted Gross Income from Forms IT-40 (Line 1), IT-40EZ (Line 1), IT-40PNR Schedule A (Line 37A). Leave blank if filing Form IT-40RNR. Line 2: Indiana Taxable Income from Forms IT-40 (Line 7), IT-40EZ (Line 5), IT-40PNR (line 7) or IT-40RNR (Lines 5A + 5B). Line 3: Total Indiana Tax from Forms IT-40 (Line 11), IT-40EZ (Line 9), IT-40PNR (Line 11) or IT-40RNR (Line 8). Line 4: Total State Tax Withheld from Forms IT-40 Schedule 5 (Line 1), IT-40EZ (Line 10), IT-40PNR Schedule F (Line1) or IT-40RNR (Line 9). Line 5: Total County Tax Withheld from Forms IT-40 Schedule 5 (Line 2), IT-40EZ (Line 11), IT-40PNR (Schedule F Line 2), or IT-40RNR (Line 10). Line 6: Total Indiana Tax Credits from Forms IT-40 (Line 14), IT-40EZ (Line 12), IT-40PNR (Line 14) or IT-40RNR (Line 11). Line 7: Refund from Forms IT-40 (Line 21), IT-40EZ (Line 15), IT-40PNR (Line 21) or IT-40RNR (Line 12). Line 8: Amount You Owe from Forms IT-40 (Line 26), IT-40EZ (Line 20), IT-40PNR (line 26) or IT-40RNR (Line 17). t o N o il Da M American LegalNet, Inc. www.FormsWorkFlow.com
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