DO NOT MAIL THIS FORM TO FTB
Declaration Control Number (DCN)
_______________________
Date Accepted
TAXABLE YEAR
FORM
2006
8453
California e-file Return Authorization for Individuals
Your first name and initial
Last name
Your SSN or ITIN
If joint return, spouse’s first name and initial
Last name
Spouse’s SSN or ITIN
Present home address — number and street, PO Box, rural route, or PMB no.
.
Apt. no.
Daytime telephone number
( )
City, town PO Box no., state, and ZIP Code
Part I Tax Return Information (whole dollars only)
1 California adjusted gross income. Form 540, line 17; Form 540 2EZ, line 16; Long Form 540NR, line 21; or Short Form 540NR, line 21 . 1
2 Refund or No Amount Due. (Form 540, line 69; Form 540 2EZ, line 28; Long Form 540NR, line 75; or Short Form 540NR, line 75) . 2
3 Amount you owe. (Form 540, line 65; Form 540 2EZ, line 27; Long Form 540NR, line 71; or Short Form 540NR, line 71) . . . . . . . . . 3
Part II Settle Your Account Electronically
m
m
4
Direct Deposit of Refund 5
Electronic Funds Withdrawal 5a Amount ___________________ 5b Withdrawal Date
___________
(MM/DD/YYYY)
Part III Make Estimated Tax Payments for Taxable Year 2007 These are not installment payments for the current amount you owe.
First Payment Due 4/16/07
Second Payment Due 6/15/07
Third Payment Due 9/17/07
Fourth Payment Due 1/15/08
6 Amount
7 Withdrawal Date
Part IV Banking Information
(Have you verified your banking information? Incorrect information causes delays, which may cause penalties and interest.)
All or portion of total refund you want to directly deposit:
Remaining portion of total refund:
8 Routing number ___________________________________________
11
Routing number _____________________________________________
9 Account number ___________________________________________
12
Account number _____________________________________________
10 Type of account: m Checking
m Savings
13
Type of account: m Checking
m Savings
Part V Declaration of Taxpayer(s)
I authorize my account be settled as designated in Part II. I further authorize my estimated tax payments be withdrawn from a single account by electronic funds withdrawal
as designated in Part III. I understand that the banking information I provided in Part IV will be used to complete any transactions designated in Part II or Part III. If I have
filed a joint return, this is an irrevocable appointment of the other spouse as an agent to receive the refund or authorize an electronic funds withdrawal.
Under penalties of perjury, I declare that the information I provided to my Electronic Return Originator (ERO), Transmitter, or Intermediate Service Provider, including my
name, address, and social security number (SSN) or individual taxpayer identification number (ITIN), the amounts shown in Part I above, and the banking information shown
in Parts II-IV above, agrees with the information and amounts shown on the corresponding lines of my 2006 California income tax return. To the best of my knowledge and
belief, my return is true, correct, and complete. If I am filing a balance due return, I understand that if the Franchise Tax Board (FTB) does not receive full and timely payment
of my tax liability, I remain liable for the tax liability and all applicable interest and penalties. I authorize my return and accompanying schedules and statements be transmit-
ted to the FTB by my ERO, Transmitter, or Intermediate Service Provider. If the processing of my return or refund is delayed, I authorize the FTB to disclose to my ERO,
Intermediate Service Provider, and/or the Transmitter the reason(s) for the delay or the date when the refund was sent.
Sign
Here
Your signature
Date
Spouse’s signature. If filing jointly, both must sign.
Date
For Privacy Notice, get form FTB 1131.
It is unlawful to forge a spouse’s signature.
Part VI Declaration of Electronic Return Originator (ERO) and Paid Preparer. See instructions.
I declare that I have reviewed the above taxpayer’s return and that the entries on form FTB 8453 are complete and correct to the best of my knowledge. (If I am only an
Intermediate Service Provider, I understand that I am not responsible for reviewing the taxpayer’s return. I declare, however, that form FTB 8453 accurately reflects the data
on the return.) I have obtained the taxpayer’s signature on form FTB 8453 before transmitting this return to the FTB; I have provided the taxpayer with a copy of all forms and
information that I will file with the FTB, and I have followed all other requirements described in FTB Pub. 1345, 2006 e-file Handbook for Authorized e-file Providers and in
FTB Pub. 1345A, 2006 e-file Handbook Supplement. I will keep form FTB 8453 on file for four years from the due date of the return or four years from the date the return is
filed, whichever is later, and I will make a copy available to the FTB upon request. 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. I make this declaration
based on all information of which I have knowledge.
Date
Check if
Check
ERO’s SSN/PTIN
ERO’s
also paid
if self-
ERO
m
m
signature
preparer
employed
Must
FEIN
Firm’s name (or yours
Sign
if self-employed)
ZIP Code
and address
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. I make this declaration based on all information of which I have knowledge.
Paid
Paid
Date
Check
Paid preparer’s SSN/PTIN
preparer’s
if self-
Preparer
signature
employed
Must
FEIN
Firm’s name (or yours
Sign
if self-employed)
ZIP Code
and address
FTB 8453
(REV 12-2006)
C2
For Privacy Notice, get form FTB 1131.