Form 8453 U.S. Individual Income Tax Declaration for an IRS e-file

Declaration Control Number (DCN)

–

00–

Form

8453

–2

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

Please
print or
type.

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OMB No. 1545-0074

2011

For the year January 1–December 31, 2011
▶ See instructions on back.

Department of the Treasury
Internal Revenue Service
p
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IRS Use Only—Do not write or staple in this space.

Your first name and initial

Last name

Your social security number

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

Last name

Spouse’s social security number

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

Apt. no.

City, town or post office, state, and ZIP code (If a foreign address also complete spaces below.)
Foreign country name

Foreign province/county

▲

Important!
You must enter
your SSN(s) above.

▲

Foreign postal code

FILE THIS FORM ONLY IF YOU ARE ATTACHING ONE OR MORE
OF THE FOLLOWING FORMS OR SUPPORTING DOCUMENTS.
Check the applicable box(es) to identify the attachments.
Appendix A, Statement by Taxpayer Using the Procedures in Rev. Proc. 2009-20 to Determine a Theft Loss Deduction Related
to a Fraudulent Investment Arrangement
Form 1098-C, Contributions of Motor Vehicles, Boats, and Airplanes (or equivalent contemporaneous written
acknowledgement)
Form 2848, Power of Attorney and Declaration of Representative (or POA that states the agent is granted authority to sign the
return)
Form 3115, Application for Change in Accounting Method
Form 3468 - attach a copy of the first page of NPS Form 10-168a, Historic Preservation Certification Application (Part 2—
Description of Rehabilitation), with an indication that it was received by the Department of the Interior or the State Historic
Preservation Officer, together with proof that the building is a certified historic structure (or that such status has been
requested)
Form 4136 - attach the Certificate for Biodiesel and, if applicable, Statement of Biodiesel Reseller or a certificate from the
provider identifying the product as renewable diesel and, if applicable, a statement from the reseller
Form 5713, International Boycott Report
Form 8283, Noncash Charitable Contributions, Section A, (if any statement or qualified appraisal is required) or Section B,
Donated Property, and any related attachments (including any qualified appraisal or partnership Form 8283)
Form 8332, Release / Revocation of Release of Claim to Exemption for Child by Custodial Parent (or certain pages from a
divorce decree or separation agreement, that went into effect after 1984 and before 2009) (see instructions)
Form 8858, Information Return of U.S. Persons With Respect to Foreign Disregarded Entities
Form 8864 - attach the Certificate for Biodiesel and, if applicable, Statement of Biodiesel Reseller or a certificate from the
provider identifying the product as renewable diesel and, if applicable, a statement from the reseller
Form 8885, Health Coverage Tax Credit, and all required attachments
Form 8949, Sales and Other Dispositions of Capital Assets, (or a statement with the same information), if you elect not to
report your transactions electronically on Form 8949
DO NOT SIGN THIS FORM.
For Paperwork Reduction Act Notice, see your tax return instructions.

Cat. No. 62766T

Form 8453 (2011)

Page 2

Form 8453 (2011)

General Instructions

Line Instructions

Purpose of Form

Declaration control number (DCN).
The DCN is a 14-digit number assigned
to each tax return. It should be included
in your acknowledgement message.
Clearly print or type the DCN in the top
left corner of each Form 8453 after the
IRS has acknowledged receipt of the
electronic tax return. The first two digits
are the file identification number and are
always “00.” The next six digits are the
electronic filer identification number
(EFIN). The next five digits are the batch
number and the serial number. The last
digit is the year digit (for returns filed in
2012, the year digit is “2”).

Use Form 8453 to send any required
paper forms or supporting
documentation listed next to the
checkboxes on Form 8453 (do not send
Forms W-2, W-2G, or 1099-R).
Do not attach any form or
document that is not shown on
Form 8453 next to the
CAUTION checkboxes. If you are required
to mail in any documentation
not listed on Form 8453, you cannot file
the tax return electronically.

!
▲

Note. Do not mail a copy of an
electronically filed Form 1040, 1040A,
1040EZ, or 1040-SS to the Internal
Revenue Service (IRS).

When and Where To File
If you are an ERO, you must mail Form
8453 to the IRS within 3 business days
after receiving acknowledgement that
the IRS has accepted the electronically
filed tax return.

Example. The EFIN is 509325. The
batch and serial numbers are 00056. The
DCN is 00-509325-00056-2.
Name and address. Print or type the
information in the spaces provided. If
using a foreign address, do not
abbreviate the country name.
P.O. box. Enter the box number only if
the post office does not deliver mail to
the home address.

If you are filing your tax return using an
online provider, mail Form 8453 to the
IRS within 3 business days after you
have received acknowledgement from
your intermediate service provider and/
or transmitter that the IRS has accepted
your electronically filed tax return. If you
do not receive an acknowledgement,
you must contact your intermediate
service provider and/or transmitter.

Note. The address must match the
address shown on the electronically filed
tax return.

Mail Form 8453 to:

Do not attach a payment to Form 8453.
Instead, mail it by April 17, 2012, with
Form 1040-V to the IRS at the applicable
address shown on that form. If a Form
1040-V is not available, see the
instructions for your tax return for other
ways to get forms or you can go to
IRS.gov.

Internal Revenue Service
Attn: Shipping and Receiving, 0254
Receipt and Control Branch
Austin, TX 73344-0254

Social security number (SSN). Be sure
to enter the taxpayer’s SSN in the space
provided on Form 8453. If a joint tax
return, list the SSNs in the same order as
the first names.

Payments

Form 2848. An electronically transmitted
return signed by an agent must have a
power of attorney attached to Form 8453
that specifically authorizes the agent to
sign the return.
Divorce decree or separation
agreement. If the divorce decree or
separation agreement went into effect
after 1984 and before 2009, the
noncustodial parent can attach certain
pages from the decree or agreement
instead of Form 8332. To be able to do
this, the decree or agreement must state
all three of the following.
1. The noncustodial parent can claim
the child as a dependent without regard
to any condition (such as payment of
support).
2. The other parent will not claim the
child as a dependent.
3. The years for which the claim is
released.
The noncustodial parent must attach
all of the following pages from the
decree or agreement.
• Cover page (include the other parent’s
SSN on that page).
• The pages that include all of the
information identified in (1) through (3)
above.
• Signature page with the other parent’s
signature and date of agreement.
Note. The noncustodial parent must
attach the required information even if it
was filed with a return in an earlier year.