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IRS DCN

0 0 –

–

– 7

ENTUCKY

NDIVIDUAL

NCOME

8453-K

ECLARATION

LECTRONIC

ILING

2006

42A740-S22

➤ For calendar year January 1, 2006, through December 31, 2006.

Department of Revenue

Last name

First name (Joint or combined return, give both names and initials.)

Your Social Security number

➤

Use

Kentucky

label if

Mailing address—Number and street or P.O. box

Apt. number

Spouse’s Social Security number

correct.

Otherwise

print or

City, town or post office

State

ZIP code

type.

➤

PART I—Tax Return Information (Whole Dollars Only)

Spouse

Taxpayer

1. Kentucky taxable income

740, line 11

740-EZ, line 3

.00

2. Total tax liability

740, line 28

740-EZ, line 10

.00

3. Total Kentucky withholding

740, line 30a

740-EZ, line 11

.00

4. Total estimated payments

740, line 30b

.00

5. Refunded to you

740, line 39

740-EZ, line 15

.00

6. Amount you owe

740, line 42

740-EZ, line 16

.00

PART II—

Direct Deposit of Refund or

Direct Debit of Tax Amount Due (See Instructions)

The first two numbers of the RTN must be

7. Routing transit number (RTN)

01 through 12 or 21 through 32.

8. Depositor account number (DAN)

M M

__ __ / __ __ / __ __ __ __

D D

Y Y Y Y

9. Type of account:

Savings

Checking

10. Debit amount _________________________

Debit date

PART III—Declaration of Taxpayer (Sign only after Part I is completed.)

11.

I consent that my refund be directly deposited as designated in Part II, and declare that the information shown on lines 7 through 9 is correct. If

I have filed a joint return, this is an irrevocable appointment of the other spouse as an agent to receive the refund.

12.

I do not want direct deposit of my refund or am not receiving a refund.

13.

I authorize the Kentucky Department of Revenue and its designated Financial Agent to initiate an ACH electronic funds withdrawal entry to the

financial institution account indicated above for payment of my state taxes owed on this return. To revoke a payment, I must contact the Kentucky

Department of Revenue at (502) 564-4581 no later than two business days prior to the payment (debit) 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.

If I have filed a balance due return, I understand that if the Kentucky Department of Revenue does not receive my full and timely payment of my tax liability,

I will remain liable for the tax liability and all applicable interest and penalties.

Under penalties of perjury, I declare that the information I have given my electronic return originator (ERO) or transmitter and the amounts in Part I above

agree with the amounts on the corresponding lines of the electronic portion of my 2006 Kentucky income tax return. To the best of my knowledge and belief,

my return is true, correct and complete. I consent to my ERO or transmitter sending my return and accompanying schedules and statements to the Kentucky

Department of Revenue. I also consent to the Kentucky Department of Revenue sending my ERO and/or transmitter an acknowledgment of receipt or

transmission and an indication of whether or not my return is accepted, and, if rejected, the reason(s) for the rejection.

➤

Your Signature (If joint or combined return, both must sign)

Spouse’s Signature

Telephone Number (daytime)

Date Signed

PART IV—Declaration and Signature of Electronic Return Originator and Paid Preparer

I declare that I have reviewed the above taxpayer’s return and that the entries on Form 8453-K are complete and correct to the best of my knowledge.

If I am only a collector, I am not responsible for reviewing the return and only declare that this form accurately reflects the data on this return. If Part

II is completed, I declare that I have verified the taxpayer's proof of account and it agrees with the name shown on this form. The taxpayer will have

signed this form before I submit the return. I will give the taxpayer a copy of all forms and information to be filed with the Kentucky Department of

Revenue, and have followed all other requirements in Kentucky Publication KY-1345, Kentucky Handbook for Electronic Filers of Individual Income Tax

Returns (Tax Year 2006). 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. This declaration is based

on all information of which I have any knowledge.

Check

if also paid preparer.

Check

if self-employed.

ERO's

Use Only

Signature