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DO NOT MAIL THIS FORM TO THE FTB

Date Accepted___________________________

California Online e-ﬁ le Return Authorization

TAXABLE YEAR

FORM

2010

for Individuals

8453-OL

Your ﬁ rst name and initial

Last name

Your SSN or ITIN

If joint return, spouse’s/RDP’s ﬁ rst name and initial

Last name

Spouse’s/RDP’s SSN or ITIN

Address (including number and street, PO Box, or PMB no.)

Apt. no./Ste.no. Daytime telephone number

(

)

City

State

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 32;

or Short Form 540NR, line 32). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

2 Refund or no amount due. (Form 540, line 115; Form 540 2EZ, line 28; Long Form 540NR, line 125;

or Short Form 540NR, line 125). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

3 Amount you owe. (Form 540, line 111; Form 540 2EZ, line 27; Long Form 540NR, line 121;

or Short Form 540NR, line 121). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Part II Settle Your Account Electronically for Taxable Year 2010 (Due 04/15/11)

4 Direct deposit of refund

Electronic funds withdrawal 5a Amount ___________________ 5b Withdrawal date (MM/DD/YYYY) _________________

Part III Make Estimated Tax Payments for Taxable Year 2011 These are not installment payments for the current amount you owe.

First Payment

Second Payment

Third Payment

Fourth Payment

Due 4/15/11

Due 6/15/11

Due 9/15/11

Due 1/17/12

6 Amount

7 Withdrawal date

Part IV Banking Information (Have you veriﬁ ed your banking information?)

8 Amount of refund to be directly deposited to account below _____________ 12 The remaining amount of my refund for direct deposit _________________

9 Routing number _______________________________________________ 13 Routing number _______________________________________________

10 Account number _______________________________________________ 14 Account number ______________________________________________

11 Type of account:

Checking

Savings

15 Type of account:

Checking

Savings

Part V Declaration of Taxpayer(s)

I authorize my account to be settled as designated in Part II. If I check Part II, box 4, I declare that the direct deposit refund information in

Part IV agrees with the authorization stated on my return. I authorize an electronic funds withdrawal for the amount listed on line 5a and any

estimated payment amounts listed on line 6 from the account listed on lines 9, 10, and 11. If I have ﬁ led a joint return, this is an irrevocable

appointment of the other spouse/RDP 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 the Franchise Tax Board (FTB), either directly or through e-ﬁ le

software, including my name, address, and social security number (SSN) or individual taxpayer identiﬁ cation number (ITIN), and the

amounts shown in Part I above, agrees with the information and amounts shown on the corresponding lines of my 2010 California income

tax return. To the best of my knowledge and belief, my return is true, correct, and complete. If I am ﬁ ling a balance due return, I understand

that if the 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 to be transmitted to the FTB directly or through the e-ﬁ le

software. If the processing of my return or refund is delayed, I authorize the FTB to disclose to me, either directly or through the e-ﬁ le

software, the reason(s) for the delay or the date when the refund was sent.

Sign

Here

Your signature

Date

Spouse’s/RDP’s signature. If ﬁ ling jointly, both must sign.

Date

It is unlawful to forge a spouse’s/RDP’s signature.

FTB 8453-OL

2010

For Privacy Notice, get form FTB 1131.

Form 8453-Ol - California Online E-Fi Le Return Authorization For Individuals - 2010

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