Form 8453-EO Exempt Organization Declaration and Signature for Electr

Form

Exempt Organization Declaration and Signature for
Electronic Filing

8453-EO

For calendar year 2016, or tax year beginning

, 2016, and ending

OMB No. 1545-1879

2016

, 20

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

Department of the Treasury
Internal Revenue Service
Name of exempt organization

Employer identification number

Type of Return and Return Information (Whole Dollars Only)

Part I

Check the box for the type of return being filed with 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 of the return being filed with 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 990 check here ▶
b Total revenue, if any (Form 990, Part VIII, column (A), line 12) . .
Form 990-EZ check here ▶
b Total revenue, if any (Form 990-EZ, line 9) . . . . . . .
Form 1120-POL check here ▶
b Total tax (Form 1120-POL, line 22) . . . . . . . . .
Form 990-PF check here ▶
b Tax based on investment income (Form 990-PF, Part VI, line 5)
Form 8868 check here ▶
b Balance due (Form 8868, line 3c) . . . . . . . . . . .

Declaration of Officer

Part II
6

1b
2b
3b
4b
5b

I authorize the U.S. Treasury and its designated Financial Agent to initiate an Automated Clearing House (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/990PF (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 2016 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) the reason for any
delay in processing the return or refund, and (c) the date of any refund.

Date

Signature of officer

▲

▲

Sign
Here

Title

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

Part III

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.
Date

▲

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

Check if
also paid
preparer

Check if
selfemployed

▲

ERO’s
Use
Only

ERO’s
signature

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
Use Only

Print/Type preparer’s name

Firm’s name

Preparer’s signature

Date

PTIN

Firm’s EIN ▶

▶

Firm’s address ▶

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

Check if
selfemployed
Phone no.

Cat. No. 36606Q

Form 8453-EO (2016)

Page 2

Form 8453-EO (2016)

TIP

Instead of filing Form 8453-EO, an organization officer filing an
exempt organization’s return through 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.

Future Developments
For the latest information about developments related to Form 8453-EO and
its instructions, such as legislation enacted after they were published, go to
www.irs.gov/form8453eo.

Purpose of Form
Use Form 8453-EO to:
• 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;
• Authorize the ERO, if any, to transmit via a third-party transmitter;
• Authorize the intermediate service provider (ISP) to transmit via a thirdparty transmitter if you are filing online (not using an ERO); and
• 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 2016 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 4th 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
• 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
PIN that is used to electronically sign the return.

The officer’s signature allows the IRS to disclose to the ISP, ERO, and/or
transmitter:
• An acknowledgment that the IRS has accepted the organization’s
electronically filed return, and
• The reason(s) for a delay in processing the return or refund.
The declaration of officer must be signed and dated by:
• The president, vice president, treasurer, assistant treasurer, chief
accounting officer; or
• 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 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.
An ERO may sign the Form 8453-EO by rubber stamp, mechanical device,
or computer software program. The alternative method of signing must
include either a facsimile of the individual ERO’s signature or of the ERO’s
printed name.

Use of PTIN
Paid preparers. Anyone who is paid to prepare the organization’s return
must enter their PTIN in Part III. The PTIN entered must have been issued
after September 27, 2010. For information on applying for and receiving a
PTIN, see Form W-12, IRS Paid Preparer Tax Identification Number (PTIN)
Application and Renewal, or visit www.irs.gov/ptin.
EROs who are not paid preparers. Only EROs who are not also the paid
preparer of the return have the option to enter their PTIN or their social
security number in the ERO’s Use Only section of Part III. If the PTIN is
entered, it must have been issued after September 27, 2010. For information
on applying for and receiving a PTIN, see Form W-12, or visit
www.irs.gov/ptin.
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 EROs to provide their
identification number 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 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
. . . . . . . . . . . .
4 hr., 32 min.
Learning about the law or the form . . . . . . . . . 18 min.
Preparing, copying, assembling,
and sending the form to the IRS
. . . . . . . . . 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 send us comments from www.irs.gov/formspubs/. Click on
“More Information” and then on “Give us feedback.” Or you can also send
your comments to the Internal Revenue Service, Tax Forms and Publications
Division, 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.