Form Va-8879 - Virginia Individual Income Tax E-File Signature Authorization - 2016

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VA-8879
Virginia Individual Income Tax e-File Signature
Tax Year
Virginia Department
Authorization
2016
of Taxation
DO NOT SEND THIS VA-8879 TO THE VA DEPT OF TAXATION OR THE IRS.
IT MUST BE MAINTAINED IN YOUR FILES!
Virginia Submission Identification Number (SID)
B Your Social Security Number
Your Name
-
-
Spouse’s Name
A Spouse’s Social Security Number
-
-
A Spouse
B Yourself
Part I
Tax Return Information
1.
Federal Adjusted Gross Income (Form 760CG, Line 1; 760PY, Line 1, columns A & B; Form 763, Line 1)
2.
Virginia Adjusted Gross Income (Form 760CG, Line 9; 760PY, Line 10, columns A & B; Form 763, Line 9)
3.
Taxable Income (Form 760CG, Line 16; 760PY, Line 17, columns A & B; Form 763, Line 18)
4.
Virginia Income Tax (Form 760CG, Line 19; 760PY, Line 18, columns A & B; Form 763 Line 19)
5.
Withholding (Form 760CG, Line 20a & b; 760PY, Lines 20a & 20b; Form 763, Lines 20a & 20b)
6.
Amount you Owe (Form 760CG, Line 37; Form 760PY, Line 37; Form 763, Line 37)
7.
Refund (Form 760CG, Line 38; 760PY, Line 38; Form 763, Line 38)
Part II Declaration of Taxpayer and Signature Authorization
Under penalties of perjury, I declare that I have examined a copy of my individual income tax return and accompanying schedules and statements for the year ending
December 31, 2016, and to the best of my knowledge and belief, it is true, correct and complete. I further 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 or individual tax identification
number) and the amount shown in Part I above agree with the information and amounts shown on the corresponding lines of my electronic income tax return. If I am
filing a balance due return, I understand that if the Virginia Department of Taxation (The Department) 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 ERO, Transmitter or Intermediate Service Provider to transmit my complete
return to the Department. I have selected a personal identification number (PIN) as my signature for my electronic income tax return and, if applicable, the direct
deposit of my refund or direct debit of my tax due. In choosing either direct deposit or direct debit, I certify that the transaction does not directly involve a financial
institution outside of the territorial jurisdiction of the United States at any point in the process. Taxpayers may sign the form using a rubber stamp, mechanical device,
such as a signature pen, or computer software program.
Taxpayer’s e-File PIN: check one box only

I authorize the ERO named below to enter my e-File PIN
as my signature on my 2016 e-filed Virginia individual income tax return.
Do not enter all zeros
_____________________________________________________________________________________________________________________________
ERO Firm Name
I will enter my e-File PIN as my signature on my 2016 e-filed Virginia individual income tax return. Check this box only if you are entering your own e-File PIN
and your return is filed using the Practitioner PIN method. The ERO must complete Part III below.
Your Signature
Date
________________________________________________________________________
_________________________________________
Spouse’s e-File PIN: check one box only

I authorize the ERO named below to enter my e-File PIN
as my signature on my 2016 e-filed Virginia individual income tax return.
Do not enter all zeros
____________________________________________________________________________________________________________________________
ERO Firm Name
I will enter my e-File PIN as my signature on my 2016 e-filed Virginia individual income tax return. Check this box only if you are entering your own e-File PIN
and your return is filed using the Practitioner PIN method. The ERO must complete Part III below.
Spouse’s Signature
Date
______________________________________________________________________
_______________________________________
Part III Certification and Authentication – Practitioner PIN Method Only

ERO’s EFIN/PIN: Enter your six-digit EFIN followed by your five digit self-selected PIN.
Do not enter all zeros
I certify that the above numeric entry is my ERO EFIN/PIN, which is my signature for the 2016 Virginia individual income tax return for the taxpayer(s) indicated
above. I confirm that I am submitting this return in accordance with the requirements of the Practitioner PIN method and Virginia’s publication Handbook for
Electronic Filers of Individual Income Tax Returns (Tax Year 2016). EROs may sign the form using a rubber stamp, mechanical device, such as a signature pen, or
computer software program.
ERO’s Signature
Date
________________________________________________________________________
_______________________________________
Form VA-8879 (REV. 10/16)

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