W-4P Withholding Certificate for Pension or Annuity Payments

Caution: DRAFT FORM
This is an advance proof copy of an IRS tax form.
It is subject to change and OMB approval before it
is officially released. You can check the scheduled
release date on our web site (www.irs.gov).
If you have any comments on this draft form, you can
submit them to us on our web site. Include the word
DRAFT in your response. You may make comments
anonymously, or you may include your name and
e-mail address or phone number. We will be unable
to respond to all comments due to the high volume
we receive. However, we will carefully consider
each suggestion. So that we can properly consider
your comments, please send them to us within 30
days from the date the draft was posted.

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I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
FORM 8453, PAGE 1 of 2
MARGINS: TOP 13 mm (1⁄ 2 "), CENTER SIDES.
PAPER: WHITE WRITING, SUB. 20.
FLAT SIZE: 203 mm (8") 3 279 mm (11")
PERFORATE: (NONE)

Date

Action

Date

Signature

O.K. to print

PRINTS: HEAD to HEAD
INK: BLACK

Revised proofs
requested

DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Declaration Control Number (DCN)

00–
Form

–

f
o
s
a
6
t
0
f
0
a
2
r
/
D /22
5
0

Your first name and initial

If a joint return, spouse’s first name and initial

2006

Last name

Your social security number

Last name

Spouse’s social security number

Home address (number and street). If you have a P.O. box, see instructions.

H
E
R
E

OMB No. 1545-0074

For the year January 1–December 31, 2006
© See instructions on back.

Department of the Treasury
Internal Revenue Service

Use the
IRS label.
Otherwise,
please
print or
type.

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

U.S. Individual Income Tax Declaration
for an IRS e-file Return

8453
L
A
B
E
L

–7

Apt. no.

¶

City, town or post office, state, and ZIP code

Important!

You must enter
your SSN(s) above.

¶

Daytime phone number

(

Part I
1
2
3
4
5

1
2
3
4
5

Adjusted gross income (Form 1040, line 38; Form 1040A, line 22; Form 1040EZ, line 4)
Total tax (Form 1040, line 63; Form 1040A, line 38; Form 1040EZ, line 10)
Federal income tax withheld (Form 1040, line 64; Form 1040A, line 39; Form 1040EZ, line 7)
Refund (Form 1040, line 73a; Form 1040A, line 45a; Form 1040EZ, line 11a)
Amount you owe (Form 1040, line 75; Form 1040A, line 47; Form 1040EZ, line 12)

Declaration of Taxpayer (Sign only after Part I is completed.) Be sure to keep a copy of your tax return.

Part II
6a
b
c

)

Tax Return Information (Whole dollars only)

I consent that my refund be directly deposited as designated in the refund section of my 2006 federal income tax return (or Form 8888, if applicable).
If I have filed a joint return, this is an irrevocable appointment of the other spouse as an agent to receive the refund.
I do not want direct deposit of my refund or I am not receiving a refund.
I authorize the U.S. Treasury and its designated Financial Agent to initiate an ACH electronic funds 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 future federal tax payments that I direct to be debited through the Electronic Federal Tax Payment
System (EFTPS). In order for me to initiate future 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 I have examined a copy of my electronic individual income tax return and accompanying schedules and statements
for the tax year ending December 31, 2006, and to the best of my knowledge and belief, it is true, correct, and complete. I further declare that the amounts
in Part I above are the amounts shown on the copy of my electronic income tax return. I consent to allow my electronic return originator (ERO) to send my
return to the IRS and to receive from the IRS (a) an acknowledgment of receipt or reason for rejection of the transmission, (b) an indication of any refund
offset, (c) the reason for any delay in processing the return or refund, and (d) the date of any refund.

Sign
Here

©

Your signature

Date

©

Date

Spouse’s signature. If a joint return, both must sign.

Declaration of Electronic Return Originator (ERO) and Paid Preparer (See instructions.)

Part III

I declare that I have reviewed the above taxpayer’s return and that the entries on Form 8453 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. 1345, Handbook for Authorized IRS e-file Providers of Individual Income Tax Returns. If I am also the Paid Preparer, under penalties
of perjury, I declare that I 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 complete. This Paid Preparer declaration is based on all information of which I have any knowledge.

ERO’s
Use
Only

ERO’s
signature

©

Date

Firm’s name (or
yours if self-employed),
address, and ZIP code

Check if
also paid
preparer

©

Check
if selfemployed

ERO’s SSN or PTIN

EIN
Phone no. (

)

Under penalties of perjury, I declare that I 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 complete. This declaration is based on all information of which I have any knowledge.

Paid
Preparer’s
Use Only

©

Preparer’s
signature
Firm’s name (or
yours if self-employed),
address, and ZIP code

Date

Check
if selfemployed

©

For Paperwork Reduction Act Notice, see back of form.

Preparer’s SSN or PTIN

EIN
Phone no. (
Cat. No. 62766T

)
Form

8453

(2006)