Form 8453-Ol - California Online E-File Return Authorization

Declaration Control Number (DCN)

DO NOT MAIL THIS FORM TO FTB

Date Accepted

TAXABLE YEAR

FORM

2004

California Online e-file Return Authorization

8453-OL

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, or rural route

Apt. no.

PMB no.

Daytime telephone number

(

)

City, town or post office, state, and ZIP Code

Part I Tax Return Information (whole dollars only)

1 Refund or No Amount Due. (Form 540, line 66; Form 540 2EZ, line 24; Long Form 540NR, line 74;

or Short Form 540NR, line 74) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2 Amount you owe. (Form 540, line 70; Form 540 2EZ, line 25; Long Form 540NR, line 78;

or Short Form 540NR, line 75) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Part II Settle Your Account Electronically

Direct Deposit of Refund

Electronic Funds Withdrawal

4a Amount____________4b Withdrawal Date (MM/DD/YYYY)____________

Part III Make Estimated Tax Payments for Taxable Year 2005

These are not installment payments for the current amount you owe.

First Payment

Second Payment

Third Payment

Fourth Payment

Due 4/15/05

Due 6/15/05

Due 9/15/05

Due 1/17/06

5 Amount

6 Withdrawal Date

Part IV Banking Information

7 Routing number

Have you verified your banking information?

8 Account number

Incorrect information causes delays, which may

cause penalties and interest.

9 Type of account:

Checking

Savings

Part V Declaration of Taxpayer(s)

I authorize my account to be settled as designated in Part II. I further authorize my estimated tax payments to be withdrawn by electronic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 the Franchise Tax Board (FTB), either directly or through e-file

software, 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 2004 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 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-file 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-file software, 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

It is unlawful to forge a spouse’s signature.

FTB 8453-OL

(2004)

For Privacy Act Notice, get form FTB 1131.

Form 8453-Ol - California Online E-File Return Authorization - 2004

Related Articles

Related forms

Related Categories