Declaration Control Number (DCN)

00– – – 1 IRS Use Only—Do not write or staple in this space.

U.S. Individual Income Tax Declaration

8453-OL
Form

OMB No. 1545-1397

for an IRS e-file On-Line Return

Department of the Treasury
Internal Revenue Service
For the year January 1–December 31, 2000
䊳 See instructions on back.
2000
Your first name and initial Last name Your social security number
L
A
Use the B If a joint return, spouse’s first name and initial Last name Spouse’s social security number
IRS label. E
Otherwise, L
please
print or H
Home address (number and street). If a P.O. box, see instructions. Apt. no.
䊱 Important!
You must enter
䊱
type. E
R
your SSN(s) above.
City, town or post office, state, and ZIP code
E Daytime phone number
( )

Part I Tax Return Information (Whole dollars only)

1 Adjusted gross income (Form 1040, line 33; Form 1040A, line 19; Form 1040EZ, line 4) 1

2 Total tax (Form 1040, line 57; Form 1040A, line 35; Form 1040EZ, line 10) 2

3 Federal income tax withheld (Form 1040, line 58; Form 1040A, line 36; Form 1040EZ, line 7) 3

4 Refund (Form 1040, line 67a; Form 1040A, line 42a; Form 1040EZ, line 11a) 4

5 Amount you owe (Form 1040, line 69; Form 1040A, line 44; Form 1040EZ, line 12). See instructions 5
Part II Declaration of Taxpayer

6a I consent that my refund be directly deposited as designated in the electronic portion of my 2000 Federal income
tax return. If I have filed a joint return, this is an irrevocable appointment of the other spouse as an agent to receive
the refund.

b I do not want direct deposit of my refund or I am not receiving a refund.

c I authorize the U.S. Treasury and its designated Financial Agent to initiate an ACH debit (electronic withdrawal) entry
to the financial institution account indicated in the tax preparation software for payment of my Federal taxes owed
on this return and/or a payment of estimated tax. I further understand that this authorization may apply to subsequent
Federal tax payments that I direct to be debited through the Electronic Federal Tax Payment System (EFTPS). In
order for me to initiate subsequent payments, I request that the IRS send me a personal identification number (PIN)
to access EFTPS. This authorization is to remain in full force and effect until I notify the U.S. Treasury Financial
Agent to terminate the authorization. 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.
If I have filed a balance due return, I understand that if the IRS 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. If I have filed a joint Federal and state tax
return and there is an error on my state return, I understand my Federal return will be rejected.

Under penalties of perjury, I declare that the information I have given my intermediate service provider and/or transmitter
and the amounts in Part I above agree with the amounts on the corresponding lines of the electronic portion of my 2000
Federal income tax return. To the best of my knowledge and belief, my return is true, correct, and complete.

Sign
Here 䊳 Your signature Date 䊳 Spouse’s signature. If a joint return, both must sign. Date
For Paperwork Reduction Act Notice, see back of form. Cat. No. 15907C Form 8453-OL (2000)
Form 8453-OL (2000) Page 2

General Instructions Line Instructions If there is an amount on line 5 and you

check the box on line 6b and are paying by
A Change To Note Declaration Control Number (DCN). The check or money order, do not attach your
DCN is a 14-digit number assigned to your payment to Form 8453-OL. Instead, mail it by
Beginning in 2000, you may use Form return by your intermediate service provider April 16, 2001, with Form 1040-V to the IRS
8453-OL to authorize a direct debit entry for and/or transmitter. It should be included in at the applicable address shown on that form.
a payment of estimated tax. your acknowledgment message. Clearly type If you do not have a Form 1040-V, you may
or print the DCN in the top left corner of Form be able to get it from your intermediate
Purpose of Form 8453-OL. The first two digits are always “00”. service provider and/or transmitter. You can
Use Form 8453-OL to: The next six digits are the electronic filer also see your tax return instruction booklet for
● Authenticate the electronic portion of your identification number (EFIN). The next five other ways to get forms, including using the
2000 Form 1040, 1040A, or 1040EZ, digits are the batch number and serial IRS Web Site (www.irs.gov).
● Send any accompanying paper schedules number. The “1” represents the year the If you check the box on line 6c, you must
or statements, and return is filed (2001). ensure that the following information relating
● Provide your consent to directly deposit Example. The EFIN is 509325. The batch to the financial institution account is provided
any refund and/or authorize a direct debit number is 000. The serial number is 56. The in the tax preparation software.
entry for payment of Federal taxes owed DCN is 00-509325-00056-1. ● Routing number.
and/or a payment of estimated tax. Name and Address. If you received a ● Account number.
peel-off name and address label from the
Who Must File IRS, put the label in the name area. Cross out ● Type of account (checking or savings).
any errors and print the correct information. ● Debit amount.
If you are filing a 2000 Form 1040, 1040A, or
1040EZ through an intermediate service Add any missing items, such as your ● Debit date (date you want the debit to
provider and/or transmitter, you must file a apartment number. If you did not receive a occur).
signed 2000 Form 8453-OL with the IRS. If label, print or type the information in the Your electronically transmitted return will
you do not, you will not have filed a valid spaces provided. not be considered complete, and therefore
return for 2000, and we may not allow you to P.O. Box. Enter your box number only if the filed, unless and until the IRS receives your
file electronically next year. post office does not deliver mail to your home. signed Form 8453-OL. If a joint return, your
Note: Do not send a copy of your Note: The address must match the address spouse must also sign.
Form 1040, 1040A, or 1040EZ. shown on your electronically filed return. Your signature allows the IRS to disclose to
Social Security Number (SSN). Be sure to your intermediate service provider and/or
When and Where To File enter your SSN in the space provided on transmitter the reason(s) for a delay in
You must mail this form to the IRS on the Form 8453-OL. If a joint return, list the SSNs processing your return or refund. If you are
next working day after you have received in the same order as the first names. applying for a refund anticipation loan or
acknowledgment from your intermediate similar product, your signature also allows the
service provider and/or transmitter that the
Part I—Tax Return Information IRS to advise your intermediate service
IRS has accepted your electronically filed Line 5. Do not include any payment with provider and/or transmitter if a refund offset
return. The address should be included in Form 8453-OL. The method of payment may occur.
your acknowledgment message. If not, mail depends on whether you check the box on Refunds. Your refund should be issued within
Form 8453-OL to the IRS at the applicable line 6b or 6c. For details, see the instructions 3 weeks after the IRS has accepted your
address shown in the chart below. If you do for Part II. return. However, some refunds may be
not receive an acknowledgement, you must delayed because of compliance reviews to
contact your intermediate service provider Part II—Declaration of Taxpayer ensure that returns are accurate. Refund
and/or transmitter. Note: You must check all applicable boxes information is available on TeleTax. Call
on line 6a, 6b, and/or 6c. 1-800-829-4477.

IF you live in . . . THEN mail Form 8453-OL to this address . . .

Receipt and Control Branch
Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts,
Shipping and Receiving
New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont,
310 Lowell Street
Virginia, and all APO and FPO addresses (except Asian/Pacific)
Andover, MA 05501
Receipt and Control Branch
Illinois, Iowa, Kansas, Minnesota, Missouri, New Mexico, Oklahoma, Texas, Shipping and Receiving
Wisconsin P.O. Box 1231
Austin, TX 78767-1231
Florida, Indiana, Kentucky, Michigan, Ohio, South Carolina, West Virginia Cincinnati, OH 45999
P.O. Box 1898
Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, Tennessee Attn: 8453-OL
Memphis, TN 38101
Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nebraska, Nevada, Stop 6052
North Dakota, Oregon, South Dakota, Utah, Washington, Wyoming, and all 1160 West 1200 South
Asian/Pacific APO and FPO addresses Ogden, UT 84201

Paperwork Reduction Act Notice. We ask unless the form displays a valid OMB control circumstances. The estimated average time
for the information on this form to carry out number. Books or records relating to a form is 15 minutes. If you have comments
the Internal Revenue laws of the United or its instructions must be retained as long as concerning the accuracy of this time estimate
States. You are required to give us the their contents may become material in the or suggestions for making this form simpler,
information. We need it to ensure that you are administration of any Internal Revenue law. we would be happy to hear from you. You
complying with these laws and to allow us to Generally, tax returns and return information can write to the Tax Forms Committee,
figure and collect the right amount of tax. are confidential, as required by Internal Western Area Distribution Center, Rancho
You are not required to provide the Revenue Code section 6103. Cordova, CA 95743-0001. Do not send the
information requested on a form that is The time needed to complete and file this form to this address. Instead, see When and
subject to the Paperwork Reduction Act form will vary depending on individual Where To File on this page.