Form 8453-EO Exempt Organization Declaration and Signature for Electr

Form

OMB No. 1545-1879

Exempt Organization Declaration and Signature for
Electronic Filing

8453-EO

For calendar year 2009, or tax year beginning

, 2009, and ending

2009

, 20

For use with Forms 990, 990-EZ, 990-PF, 1120-POL, and 8868

Department of the Treasury
Internal Revenue Service

䊳

See instructions on back.

Name of exempt organization

Employer identification number

Type of Return and Return Information (Whole Dollars Only)

Part I

Check the box for the return for which you are using this Form 8453-EO and enter the applicable amount, if any, from the return.
If you check the box on line 1a, 2a, 3a, 4a, or 5a below and the amount on that line for the return for which you are filing this form
was blank, then leave line 1b, 2b, 3b, 4b, or 5b, whichever is applicable, blank (do not enter -0-). If you entered -0- on the return,
then enter -0- on the applicable line below. Do not complete more than one line in Part I.
1a
2a
3a
4a
5a

Form
Form
Form
Form
Form

990 check here 䊳
990-EZ check here 䊳
1120-POL check here
990-PF check here 䊳
8868 check here 䊳

1b
2b
3b
4b
5b

Declaration of Officer

Part II
6

䊳

b Total revenue, if any (Form 990, Part VIII, column (A), line 12)
b Total revenue, if any (Form 990-EZ, line 9)
b Total tax (Form 1120-POL, line 22)
b Tax based on investment income (Form 990-PF, Part VI, line 5)
b Balance due (Form 8868, line 3c)

I authorize the U.S. Treasury and its designated Financial Agent to initiate an ACH electronic funds withdrawal (direct debit) entry
to the financial institution account indicated in the tax preparation software for payment of the organization’s federal taxes owed
on this return, 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 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 a copy of this return is being filed with a state agency(ies) regulating charities as part of the IRS Fed/State program, I certify that
I executed the electronic disclosure consent contained within this return allowing disclosure by the IRS of this Form
990/990-EZ/990-PF (as specifically identified in Part I above) to the selected state agency(ies).

Under penalties of perjury, I declare that I am an officer of the above named organization and that I have examined a copy of the
organization’s 2009 electronic return and accompanying schedules and statements and to the best of my knowledge and belief, they are
true, correct, and complete. I further declare that the amount in Part I above is the amount shown on the copy of the organization’s
electronic return. I consent to allow my intermediate service provider, transmitter, or electronic return originator (ERO) to send the
organization’s return to the IRS and to receive from the IRS (a) an acknowledgement 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
Part III

䊳

䊳

Date

Signature of officer

Title

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

I declare that I have reviewed the above organization’s return and that the entries on Form 8453-EO 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 organization officer will have signed this form before I submit the return. I will give the officer a copy of all
forms and information to be filed with the IRS, and have followed all other requirements in 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 the above organization’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

䊳

Date

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

Check if
also paid
preparer

䊳

Check
if selfemployed

ERO’s SSN or PTIN

EIN
Phone no. (

)

Under penalties of perjury, I declare that I have examined the above return and accompanying schedules and statements, and to the best of my knowledge
and belief, they are true, correct, and complete. Declaration of preparer is based on all information of which the preparer has any knowledge.

Paid
Preparer’s
Use Only

䊳

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

Date

䊳

For Privacy Act and Paperwork Reduction Act Notice, see back of form.

Check
if selfemployed

Preparer’s SSN or PTIN

EIN
Phone no. (
Cat. No. 36606Q

Form

)

8453-EO

(2009)

Form 8453-EO (2009)

Instead of filing Form 8453-EO, an organization
officer filing an exempt organization’s return through
TIP
an electronic return originator (ERO) can sign the
return using a personal identification number (PIN).
For details, see Form 8879-EO, IRS e-file Signature Authorization
for an Exempt Organization.

Purpose of Form
Use Form 8453-EO to:

Page

● Debit date (date the organization wants the debit to occur).
An electronically transmitted return will not be considered
complete (and therefore not considered filed) unless either:
● Form 8453-EO is signed by an organization officer, scanned
into a PDF file, and transmitted with the return, or
● The return is filed through an ERO and Form 8879-EO is used
to select a personal identification number (PIN) that is used to
electronically sign the return.

● Authenticate the electronic Form 990, Return of Organization
Exempt From Income Tax; Form 990-EZ, Short Form Return of
Organization Exempt From Income Tax; Form 990-PF, Return of
Private Foundation; Form 1120-POL, U.S. Income Tax Return for
Certain Political Organizations; or Form 8868, Application for
Extension of Time To File an Exempt Organization Return;

The officer’s signature allows the IRS to disclose to the ISP,
ERO, and/or transmitter:

● Authorize the electronic return originator (ERO), if any, to
transmit via a third-party transmitter;

● If a refund offset may occur.

● Authorize the intermediate service provider (ISP) to transmit via
a third-party transmitter if you are filing online (not using an
ERO); and

● The president, vice president, treasurer, assistant treasurer,
chief accounting officer, or

● Authorize an electronic funds withdrawal for payment of
federal taxes owed (Form 990-PF, Form 1120-POL, or Form
8868 with payment).

Who Must File
If you are filing a 2009 Form 990, Form 990-EZ, Form 990-PF,
Form 1120-POL, or Form 8868 with payment through an ISP
and/or transmitter and you are not using an ERO, you must file
Form 8453-EO with your electronically filed return. An ERO can
use either Form 8453-EO or Form 8879-EO to obtain
authorization to file an organization’s Form 990, Form 990-EZ,
Form 990-PF, or Form 1120-POL, or to file a Form 8868 with
payment.

When To File
Form 990, Form 990-EZ, and Form 990-PF. File Form 990,
Form 990-EZ, or Form 990-PF by the 15th day of the 5th month
after the organization’s accounting period ends. If the regular
due date falls on a Saturday, Sunday, or legal holiday, the
organization may file on the next business day. The Form
8453-EO must be filed with the electronically filed Form 990,
Form 990-EZ, or Form 990-PF.
Form 1120-POL. File Form 1120-POL by the 15th day of the 3rd
month after the organization’s accounting period ends. If the
regular due date falls on a Saturday, Sunday, or legal holiday,
the organization may file on the next business day. The Form
8453-EO must be filed with the electronically filed Form
1120-POL.
Form 8868. Generally, file Form 8868 by the due date of
the return for which you are requesting an extension. The Form
8453-EO must be filed with the electronically filed Form 8868.

How To File
File Form 8453-EO with the organization’s electronically filed
return. Use a scanner to create a PDF file of the completed form.
Your tax preparation software will allow you to transmit this PDF
file with the return.

Part II. Declaration of Officer
If a Form 990-PF, Form 1120-POL, or Form 8868 filer chooses
to pay the tax due by electronic funds withdrawal (direct debit),
check the box. Otherwise, leave the box blank.
If the officer checks the box when filing Form 990-PF, Form
1120-POL, or Form 8868 with payment, the officer must ensure
that the following information relating to the financial institution
account is provided in the tax preparation software.
● Routing number,
● Account number,
● Type of account (checking or savings),
● Debit amount, and

2

● An acknowledgment that the IRS has accepted the
organization’s electronically filed return,
● The reason(s) for a delay in processing the return or refund, and
The declaration of officer must be signed and dated by:

● Any other organization officer authorized to sign the
organization’s return.
If this return contains instructions to the IRS to provide a
copy(ies) of the return to a state agency(ies) regulating charities
as part of the IRS Fed/State program, the checkbox in Part II
must be checked.

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 the ERO’s Use
Only section in Part III.
If the organization’s return is filed through an ERO, the IRS
requires the ERO’s signature. A paid preparer, if any, must sign
Form 8453-EO in the space for Paid Preparer’s Use Only. But if
the paid preparer is also the ERO, do not complete the paid
preparer’s section. Instead, check the box labeled Check if also
paid preparer.
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 return preparers 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. The rules governing the confidentiality of
the Form 990, Form 990-EZ, and Form 990-PF are covered in
section 6104. Generally, tax returns (Form 1120-POL) and return
information are confidential, as required by section 6103.
The time needed to complete and file this form will vary
depending on individual circumstances. The estimated average
time is:
Recordkeeping
Learning about the law or the form
Preparing, copying, assembling,
and sending the form to the IRS

4 hr., 32 min.
18 min.
22 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:T:SP, 1111 Constitution Ave. NW, IR-6526,
Washington, DC 20224. Do not send Form 8453-EO to this
address. Instead, see How To File on this page.