Fillable Form 8879 - Signature Authorization printable pdf download

8879

OMB No. 1545-0074

IRS e-file Signature Authorization

Form

2006

Do not send to the IRS. This is not a tax return.

Department of the Treasury

Keep this form for your records. See instructions.

Internal Revenue Service

Declaration Control Number (DCN)

Taxpayer’s name

Social security number

Spouse’s name

Spouse’s social security number

Part I

Tax Return Information—Tax Year Ending December 31, 2006 (Whole Dollars Only)

Adjusted gross income (Form 1040, line 38; Form 1040A, line 22; Form 1040EZ, line 4)

Total tax (Form 1040, line 63; Form 1040A, line 37; Form 1040EZ, line 11)

Federal income tax withheld (Form 1040, line 64; Form 1040A, line 38; Form 1040EZ, line 7)

Refund (Form 1040, line 74a; Form 1040A, line 45a; Form 1040EZ, line 12a; Form 1040EZ-T, line 1a)

Amount you owe (Form 1040, line 76; Form 1040A, line 47; Form 1040EZ, line 13)

Part II

Taxpayer Declaration and Signature Authorization (Be sure you get and keep a copy of your return)

Under penalties of perjury, I declare that I have examined a copy of my electronic individual income tax return or request for refund and accompanying

schedules and statements for the tax year ending December 31, 2006, and to the best of my knowledge and belief, it is true, correct, and complete. I further

declare that the amounts in Part I above are the amounts from my electronic income tax return or request for refund. I consent to allow my intermediate

service provider, transmitter, or electronic return originator (ERO) to send my return or request to the IRS and to receive from the IRS (a) an acknowledgement

of receipt or reason for rejection of the transmission, (b) an indication of any refund offset, (c) the reason for any delay in processing the return or refund, and

(d) the date of any refund. If applicable, I authorize the U.S. Treasury and its designated Financial Agent to initiate an ACH electronic funds withdrawal (direct

debit) entry to the financial institution account indicated in the tax preparation software for payment of my Federal taxes owed on this return and/or a payment

of estimated tax, and the financial institution to debit the entry to this account. I further understand that this authorization may apply to future Federal tax

payments that I direct to be debited through the Electronic Federal Tax Payment System (EFTPS). In order for me to initiate future payments, I request that

the IRS send me a personal identification number (PIN) to access EFTPS. This authorization is to remain in full force and effect until I notify the U.S. Treasury

Financial Agent to terminate the authorization. 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. I further acknowledge that the personal identification

number (PIN) below is my signature for my electronic income tax return or request for refund and, if applicable, my Electronic Funds Withdrawal Consent.

Taxpayer’s PIN: check one box only

I authorize

to enter or generate my PIN

ERO firm name

do not enter all zeros

as my signature on my tax year 2006 electronically filed income tax return or request for refund.

I will enter my PIN as my signature on my tax year 2006 electronically filed income tax return or request for refund. Check

this box only if you are entering your own PIN and your return or request is filed using the Practitioner PIN method. The

ERO must complete Part III below.

Your signature

Date

Spouse’s PIN: check one box only

I authorize

to enter or generate my PIN

ERO firm name

do not enter all zeros

as my signature on my tax year 2006 electronically filed income tax return or request for refund.

I will enter my PIN as my signature on my tax year 2006 electronically filed income tax return or request for refund. Check

this box only if you are entering your own PIN and your return or request is filed using the Practitioner PIN method. The

ERO must complete Part III below.

Spouse’s signature

Date

Practitioner PIN Method Returns Only—continue below

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 PIN, which is my signature for the tax year 2006 electronically filed income tax return or request for refund 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 Publication

1345, Handbook for Authorized IRS e-file Providers of Individual Income Tax Returns.

ERO’s signature

Date

ERO Must Retain This Form — See Instructions

Do Not Submit This Form to the IRS Unless Requested To Do So

8879

Form

(2006)

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

Cat. No. 32778X