Form Pa-8453 "Pennsylvania Individual Income Tax Declaration for Electronic Filing" - Pennsylvania

Form PA-8453 is a Pennsylvania Department of Revenue form also known as the "Pennsylvania Individual Income Tax Declaration For Electronic Filing". The latest edition of the form was released in April 1, 2018 and is available for digital filing.

Download an up-to-date Form PA-8453 in PDF-format down below or look it up on the Pennsylvania Department of Revenue Forms website.

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Declaration Control Number/Submission ID
START
PA DEPARTMENT OF REVENUE USE ONLY – DO NOT WRITE OR STAPLE IN THIS SPACE
PA-8453
PENNSYLVANIA INDIVIDUAL INCOME TAX
2018
Form
DECLARATION FOR ELECTRONIC FILING
(EX) 04-18
For the year Jan. 1 – Dec. 31, 2018
Primary Taxpayer’s Social Security Number
Secondary Taxpayer’s Social Security Number
Last Name
Primary Taxpayer’s Name, Initial; Secondary Taxpayer’s First Name, Initial; Secondary Taxpayer’s Last Name (only if different)
Print
or
Home Address (Number and Street including Rural Route or P.O. Box)
Type
City, Town or Post Office
State
ZIP Code
The above information must match that on the electronic return exactly.
£
£
£
Check
£
£
S
Single
J
Married, Filing Jointly
D
Deceased
Daytime Telephone Number
Proper
NO DASHES
M
Married, Filing Separately
F
Final Return
(
)
Filing Status
P
Part I
Tax Return Information (Enter whole dollars only.)
1. Adjusted PA taxable income (Form PA-40, Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.
E
2. PA tax liability (Form PA-40, Line 12) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.
3. Total PA tax withheld (Form PA-40, Line 13) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.
N
4. Amount to be refunded (Form PA-40, Line 30) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.
5. Total payment (tax due) (Form PA-40, Line 28) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.
N
Part II
Direct Deposit of Refund or Electronic Funds Withdrawal of Tax Due (Optional – See instructions.)
The first two numbers of the RTN must
6. Routing transit number (RTN)
S
be 01 through 12 or 21 through 32.
7. Depositor account number (DAN)
£
£
Y
8. Type of account:
Checking
Savings
MMDDYYYY
.
9
Debit date
L
Part III
Declaration of Taxpayers (Sign only after Part I is complete.)
£
V
a.
10.
I
consent for my refund to be directly deposited as designated in Part II and declare all information shown on Lines 6 through 8 is correct. I certify the ultimate
destination of the funds is within the U.S. or one of its territories. If I have filed a joint return, this is an irrevocable appointment of the other Taxpayer as
£
an agent to receive the refund.
A
b.
£
I am not receiving a refund or I do not want direct deposit of my refund.
c.
I authorize the Pennsylvania Department of Revenue and its designated financial agents to initiate an electronic funds withdrawal entry to my designated
account for Pennsylvania taxes owed. I also authorize my financial institution to debit the entry to my account and the financial institutions involved in
N
the processing of my electronic payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to
my payment. I certify the funds for this withdraw are originating from an account within the U.S. or one of its territories. I may revoke this authorization by
notifying the Pennsylvania Department of Revenue no later than two business days prior to the payment (settlement) date. I understand notification must
be made in writing by email to ra-achrevok@pa.gov or fax to 717-772-9310.
I
If I have filed a balance-due return, I understand that if the PA Department of Revenue does not receive full and timely payment of my tax liability, I will remain liable for the tax 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.
I declare under penalties of perjury that I have compared the information on my return with the information I provided to my electronic return originator and the amounts match those
A
on my 2018 PA Tax Return (PA-40). To the best of my knowledge, my return is true and complete. I authorize my electronic return originator to send my return and accompanying schedules
and statements to the Internal Revenue Service (IRS) and the IRS to subsequently send them to the PA Department of Revenue. In addition, by using a computer system and software to
prepare and transmit my return electronically, I consent to the disclosure of all information pertaining to my use of the system and software and to the transmission of my tax return
electronically to the PA Department of Revenue. If I am filing from a home computer, I understand that I am required to keep this form and supporting documents for three years.
MMDDYYYY
MMDDYYYY
Signature of Primary Taxpayer – Please sign after printing
Signature of Secondary Taxpayer – Please sign after printing
Sign
Primary Taxpayer
Date
Secondary Taxpayer
Date
Here
Part
IV
Declaration of Electronic Return Originator (ERO) and Paid Preparer (See instructions.)
I declare that I have received the above-named taxpayer’s return and that the entries on this form are complete and correct to the best of my knowledge. I obtained the taxpayer’s
signature on this form before submitting this return to the PA Department of Revenue. I provided the taxpayer with a copy of all forms and information to be filed with the IRS and the
PA Department of Revenue and followed all other requirements specified by the PA Department of Revenue and described in the IRS Publication 1345, Handbook for Electronic Filers
of Individual Tax Returns (Tax Year 2018). If I am the preparer, under penalty of perjury, I declare that I examined the above-named taxpayer’s return and accompanying schedules and
statements, and to the best of my knowledge, they are true and complete. I understand that I am required to keep this form and supporting documents for three years.
£
£
MMDDYYYY
Check if also
Check if
ERO’s signature
Date
EIN/SSN or PTIN
ERO’s
paid preparer
self-employed
Signature of ERO – Sign after printing
Use
FIRM NAME AND ADDRESS
Only
Firm’s name (or yours,
if self-employed) and
CITY
ZIP CODE
NO DASHES
STATE
Daytime Telephone Number (
)
address
£
£
MMDDYYYY
Preparer’s signature
Date
EIN/SSN or PTIN
Check if also
Check if
Signature of Preparer – Please sign after printing
paid preparer
self-employed
Paid
FIRM NAME AND ADDRESS
Firm’s name (or yours,
Preparer’s
if self-employed) and
Use Only
address
NO DASHES
CITY
STATE
ZIP CODE
Daytime Telephone Number (
)
KEEP THIS FORM AND THE REQUIRED ATTACHMENTS FOR THREE YEARS.
Please DO NOT mail this form.
Reset Entire Form
TOP OF PAGE
NEXT PAGE
PRINT
Declaration Control Number/Submission ID
START
PA DEPARTMENT OF REVENUE USE ONLY – DO NOT WRITE OR STAPLE IN THIS SPACE
PA-8453
PENNSYLVANIA INDIVIDUAL INCOME TAX
2018
Form
DECLARATION FOR ELECTRONIC FILING
(EX) 04-18
For the year Jan. 1 – Dec. 31, 2018
Primary Taxpayer’s Social Security Number
Secondary Taxpayer’s Social Security Number
Last Name
Primary Taxpayer’s Name, Initial; Secondary Taxpayer’s First Name, Initial; Secondary Taxpayer’s Last Name (only if different)
Print
or
Home Address (Number and Street including Rural Route or P.O. Box)
Type
City, Town or Post Office
State
ZIP Code
The above information must match that on the electronic return exactly.
£
£
£
Check
£
£
S
Single
J
Married, Filing Jointly
D
Deceased
Daytime Telephone Number
Proper
NO DASHES
M
Married, Filing Separately
F
Final Return
(
)
Filing Status
P
Part I
Tax Return Information (Enter whole dollars only.)
1. Adjusted PA taxable income (Form PA-40, Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.
E
2. PA tax liability (Form PA-40, Line 12) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.
3. Total PA tax withheld (Form PA-40, Line 13) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.
N
4. Amount to be refunded (Form PA-40, Line 30) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.
5. Total payment (tax due) (Form PA-40, Line 28) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.
N
Part II
Direct Deposit of Refund or Electronic Funds Withdrawal of Tax Due (Optional – See instructions.)
The first two numbers of the RTN must
6. Routing transit number (RTN)
S
be 01 through 12 or 21 through 32.
7. Depositor account number (DAN)
£
£
Y
8. Type of account:
Checking
Savings
MMDDYYYY
.
9
Debit date
L
Part III
Declaration of Taxpayers (Sign only after Part I is complete.)
£
V
a.
10.
I
consent for my refund to be directly deposited as designated in Part II and declare all information shown on Lines 6 through 8 is correct. I certify the ultimate
destination of the funds is within the U.S. or one of its territories. If I have filed a joint return, this is an irrevocable appointment of the other Taxpayer as
£
an agent to receive the refund.
A
b.
£
I am not receiving a refund or I do not want direct deposit of my refund.
c.
I authorize the Pennsylvania Department of Revenue and its designated financial agents to initiate an electronic funds withdrawal entry to my designated
account for Pennsylvania taxes owed. I also authorize my financial institution to debit the entry to my account and the financial institutions involved in
N
the processing of my electronic payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to
my payment. I certify the funds for this withdraw are originating from an account within the U.S. or one of its territories. I may revoke this authorization by
notifying the Pennsylvania Department of Revenue no later than two business days prior to the payment (settlement) date. I understand notification must
be made in writing by email to ra-achrevok@pa.gov or fax to 717-772-9310.
I
If I have filed a balance-due return, I understand that if the PA Department of Revenue does not receive full and timely payment of my tax liability, I will remain liable for the tax 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.
I declare under penalties of perjury that I have compared the information on my return with the information I provided to my electronic return originator and the amounts match those
A
on my 2018 PA Tax Return (PA-40). To the best of my knowledge, my return is true and complete. I authorize my electronic return originator to send my return and accompanying schedules
and statements to the Internal Revenue Service (IRS) and the IRS to subsequently send them to the PA Department of Revenue. In addition, by using a computer system and software to
prepare and transmit my return electronically, I consent to the disclosure of all information pertaining to my use of the system and software and to the transmission of my tax return
electronically to the PA Department of Revenue. If I am filing from a home computer, I understand that I am required to keep this form and supporting documents for three years.
MMDDYYYY
MMDDYYYY
Signature of Primary Taxpayer – Please sign after printing
Signature of Secondary Taxpayer – Please sign after printing
Sign
Primary Taxpayer
Date
Secondary Taxpayer
Date
Here
Part
IV
Declaration of Electronic Return Originator (ERO) and Paid Preparer (See instructions.)
I declare that I have received the above-named taxpayer’s return and that the entries on this form are complete and correct to the best of my knowledge. I obtained the taxpayer’s
signature on this form before submitting this return to the PA Department of Revenue. I provided the taxpayer with a copy of all forms and information to be filed with the IRS and the
PA Department of Revenue and followed all other requirements specified by the PA Department of Revenue and described in the IRS Publication 1345, Handbook for Electronic Filers
of Individual Tax Returns (Tax Year 2018). If I am the preparer, under penalty of perjury, I declare that I examined the above-named taxpayer’s return and accompanying schedules and
statements, and to the best of my knowledge, they are true and complete. I understand that I am required to keep this form and supporting documents for three years.
£
£
MMDDYYYY
Check if also
Check if
ERO’s signature
Date
EIN/SSN or PTIN
ERO’s
paid preparer
self-employed
Signature of ERO – Sign after printing
Use
FIRM NAME AND ADDRESS
Only
Firm’s name (or yours,
if self-employed) and
CITY
ZIP CODE
NO DASHES
STATE
Daytime Telephone Number (
)
address
£
£
MMDDYYYY
Preparer’s signature
Date
EIN/SSN or PTIN
Check if also
Check if
Signature of Preparer – Please sign after printing
paid preparer
self-employed
Paid
FIRM NAME AND ADDRESS
Firm’s name (or yours,
Preparer’s
if self-employed) and
Use Only
address
NO DASHES
CITY
STATE
ZIP CODE
Daytime Telephone Number (
)
KEEP THIS FORM AND THE REQUIRED ATTACHMENTS FOR THREE YEARS.
Please DO NOT mail this form.
Reset Entire Form
TOP OF PAGE
NEXT PAGE
PRINT
THIS PAGE DOES NOT PRINT
2018
Pennsylvania Department of Revenue
Instructions for PA-8453
Individual Income Tax Declaration for Electronic Filing
PA-8453 IN (EX) 04-18
and wife use different last names,
by electronic funds withdrawal by
FILING OF FORM PA-8453
please separate the names. For
completing Part II.
example, Paul A. Smith and Joan A.
If a taxpayer elects not to use the
Line 6 - The routing transit number
Weston would be Smith, Paul A. and
federal self-select PIN or a return is
(RTN) must contain nine digits. If the
Joan A. Weston.
filed without a federal return, electronic
RTN does not begin with 01 through
return originators (EROs) and trans-
The address on this form must match
12, or 21 through 32, the direct
mitters must retain completed Forms
the address on the electronically filed
deposit or electronic funds withdrawal
PA-8453 and supporting documents
PA-40.
request will be rejected.
for three years after the due date of
the return or the date the return was
Line 7 - The depositor account
PART I – TAX RETURN
filed electronically, whichever is later.
number (DAN) may contain up to 17
INFORMATION
EROs and transmitters must make the
alphanumeric characters. Include
documents available to the PA
hyphens but omit spaces and special
Line 1 - Enter adjusted PA taxable
Department of Revenue upon request.
symbols. If fewer than 17 characters,
income from Line 11, Form PA-40.
Do not mail Form PA-8453 and
enter the number from left to right and
attachments to the PA Department of
leave the unused boxes blank.
Line 2 - Enter PA tax liability from
Revenue unless requested.
Line 12, Form PA-40.
Line 8 - Check the appropriate box.
NOTE: If an ERO or transmitter
Line 3 - Enter total PA tax withheld
Line 9 - Debit Date - Enter the date
closes its business, it must mail
from Line 13, Form PA-40.
the taxpayer wants the payment
all forms to the following address with
electronically withdrawn, on or before
Line 4 - Enter the amount to be
a letter of explanation.
April 15, 2019.
refunded from Line 30, Form PA-40.
PA DEPARTMENT OF REVENUE
NOTE: The account cannot
Line 5 - Enter total payment (tax due),
BUREAU OF INDIVIDUAL TAXES
include the name of any other
from Line 28, Form PA-40.
ELECTRONIC FILING SECTION
person unless the taxpayer’s filing
PO BOX 280507
Taxpayers
are
responsible
for
status on the return is “married filing
HARRISBURG PA 17128-0507
submitting payment due to the PA
jointly” or “married filing separately,”
Department of Revenue by April 15,
Any taxpayer filing electronically from
and the taxpayer’s spouse is the other
2019.
a home computer must keep the
name listed on the account.
signed Form PA-8453 and supporting
Payment may be sent along with
Some financial institutions do not
documents for three years after the
Form PA-40 V. If Form PA-40 V was
permit the deposit of a joint refund
due date of the return or the date the
not received, it may be completed
in an individual account. The PA
return was filed electronically, which-
online, printed and mailed to the
Department of Revenue is not
ever is later. Taxpayers must make the
department with payment. Check or
responsible
when
a
financial
documents available to the PA
money order should be made payable
institution refuses a direct deposit.
Department of Revenue upon request.
to the PA Dept. of Revenue. The last
Do not mail Form PA-8453 and
To be eligible for direct deposit or
four digits of the taxpayer’s Social
attachments to the PA Department of
electronic funds withdrawal, taxpayers
Security number, “2018 PA-V” and
Revenue unless requested.
must provide proof of account owner-
daytime telephone number should be
ship to the ERO. An acceptable proof
written on the payment.
LINE INSTRUCTIONS
of account ownership is a check, form,
PA DEPT. OF REVENUE
FORM 8453
report or other statement generated
PAYMENT ENCLOSED
by the financial institution that has the
1 REVENUE PLACE
taxpayer’s name, RTN and DAN
Submission ID - The Submission ID
HARRISBURG PA 17129-0001
preprinted on it.
is a 20-digit number assigned by the
ERO to a taxpayer’s return.
For accounts payable through a
PART II – DIRECT DEPOSIT
financial institution other than the one
Name, Address and Social Security
OF REFUND OR
Number Print or type the taxpayer’s
at which the account is located, the
ELECTRONIC FUNDS
name (last name first) and complete
taxpayer must provide a document,
address including ZIP code. In the
such as an account statement or
WITHDRAWAL
spaces provided, enter the taxpayer’s
identification card, showing the RTN
Social Security number and that of the
Taxpayers may elect to have refunds
of the bank or institution where the
spouse, if applicable. If a husband
directly deposited or payments made
account is located. A deposit slip
www.revenue.pa.gov
PA-8453
1
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should not be used to verify RTN or
the debit date. Written requests to
the ERO must have the taxpayer
DAN because it can contain internal
revoke the electronic funds withdrawal
complete and sign a corrected Form
routing numbers that are not part of
must include the taxpayer’s name,
PA-8453.
the RTN.
address, Social Security number,
RTN, DAN and payment amount.
PART IV – DECLARATION
If there is any doubt about the correct
Written requests can be faxed to
OF ELECTRONIC RETURN
RTN, the taxpayer should contact the
7 1 7 - 7 7 2 - 9 3 1 0 o r e m a i l e d t o
financial institution for assistance.
ORIGINATOR (ERO)
ra-achrevok@pa.gov.
AND PREPARER
NOTE: Some financial institutions
After a return has been prepared and
may not accept direct deposits
before the return is transmitted, the
The ERO must sign this form and
into
accounts
payable
through
taxpayer (or both taxpayers, if filing
keep it with the required attachments
another bank or financial institution,
jointly) must verify the information on
for three years.
including credit unions.
the return and sign and date the
completed Form PA-8453. If you are
A preparer must sign the Form PA-8453
PART III – DECLARATION
responsible for the affairs of a minor,
in the space for Preparer. If the
OF TAXPAYER
preparer is also the ERO, do not
disabled person, or a decedent who
complete
the
Preparer
Section;
could not prepare his or her own PA
Line 10 - All filers must check one of
tax return, you must sign to file a valid
instead, check the box labeled “Check
the boxes.
tax return. The ERO must provide the
if also paid preparer.”
taxpayer with a copy of this form.
NOTE: Taxpayers may revoke
the electronic funds withdrawal
If the ERO makes changes to the
authorization by notifying the PA
electronic return after the Form
Department of Revenue in writing no
PA-8453 has been signed by the
later than two business days prior to
taxpayer, but before it is transmitted,
2
PA-8453
www.revenue.pa.gov
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