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I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
Form 8453-X, PAGE 1 of 2 (page 2 is blank)
MARGINS: TOP 13 mm (1⁄2"), CENTER SIDES.
PAPER: WHITE, WRITING, SUB. 20
FLAT SIZE: 203 mm (8") ⫻ 279 mm (11")
PERFORATE: ON FOLD
Date
8453-X
(July 2003)
Department of the Treasury
Internal Revenue Service
Part I
Date
Signature
O.K. to print
PRINTS: HEAD to HEAD
INK: BLACK
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT
Form
Action
Revised proofs
requested
Political Organization
Declaration for Electronic Filing of
Notice of Section 527 Status
OMB No. 1545-1693
Notice Information
1
Name of organization
2
Mailing address (P.O. box or number, street, and room or suite number)
Employer identification number
City or town, state, and ZIP code
3
Confirmation number
4a Date Form 8871 filed
Part II
4b Time Form 8871 filed
Declaration
Under penalties of perjury, I declare that the organization named in Part I is to be treated as a tax-exempt organization
described in section 527 of the Internal Revenue Code, that it has filed the electronic Form 8871 referenced above, and that
I have examined that notice, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct, and complete.
Sign
Here
䊳
䊳
Signature of authorized official
Date
Instructions
After electronically submitting Form 8871, an
authorized official must sign, date, and send Form
8453-X to:
that must be used to file an amended or final Form
8871 or to electronically file Form 8872, Political
Organization Report of Contributions and Expenditures.
Internal Revenue Service
Ogden, UT 84201
Upon receipt of this form, the Internal Revenue Service
will send the organization a username and password
For Paperwork Reduction Act Notice, see separate Instructions for Form 8871.
Cat. No. 36512T
Form
8453-X
(7-2003)
File Type | application/pdf |
File Modified | 2003-06-30 |
File Created | 2003-06-30 |