Form 8453-Eo - California E-File Return Authorization For Exempt Organizations - 2011

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_______________________

DO NOT MAIL THIS FORM TO FTB

Date Accepted

California e-file Return Authorization for

FORM

TAXABLE YEAR

Exempt Organizations

8453-EO

2011

Exempt Organization name

Identifying number

Part I Electronic Return Information (whole dollars only)

1 Total gross receipts (Form 199, line 4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1___________________

2 Total gross income (Form 199, line 8). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2___________________

3 Total expenses and disbursements (Form 199, Line 9) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3___________________

Part II Settle Your Account Electronically for Taxable Year 2011

Electronic funds withdrawal

4a Amount ______________________

4b Withdrawal date (MM/DD/YYYY) _____________________

Part III Banking Information (Have you verified the exempt organization’s banking information?)

5 Routing number______________________________________________

6 Account number______________________________________________ 7 Type of account:

Checking

Savings

Part IV Declaration of Officer

I authorize the exempt organization’s account be settled as designated in Part II. If I check Part ll, Box 4, I authorize an electronic funds withdrawal for the

amount listed on line 4a.

Under penalties of perjury, I declare that I am an officer of the above exempt organization and that the information I provided to my Electronic return originator

(ERO), transmitter, or intermediate service provider and the amounts in Part I above agree with the amounts on the corresponding lines of the exempt

organization’s 2011 California electronic return. To the best of my knowledge and belief, the exempt organization’s return is true, correct, and complete. If

the exempt organization is filing a balance due return, I understand that if the Franchise Tax Board (FTB) does not receive full and timely payment of the

exempt organization’s fee liability, the exempt organization will remain liable for the fee liability and all applicable interest and penalties. I authorize the exempt

organization return and accompanying schedules and statements be transmitted to the FTB by the ERO, transmitter, or intermediate service provider. If the

processing of the exempt organization’s return or refund is delayed, I authorize the FTB to disclose to the ERO, intermediate service provider, the

reason(s) for the delay.



Sign

Here

Signature of Officer

Date

Title

Part V Declaration of Electronic Return Originator (ERO) and Paid Preparer. See instructions.

I declare that I have reviewed the above exempt organization’s return and that the entries on form FTB 8453-EO are complete and correct to the best of my

knowledge. (If I am only an Intermediate Service Provider, I understand that I am not responsible for reviewing the exempt organization’s return. I declare,

however, that form FTB 8453-EO accurately reflects the data on the return.) I have obtained the organization officer’s signature on form FTB 8453-EO before

transmitting this return to the FTB; I have provided the organization officer with a copy of all forms and information that I will file with the FTB, and I have

followed all other requirements described in FTB Pub. 1345B, 2011 Business e-file Handbook for Authorized e-file Providers, and in FTB Pub. 1345, 2011

e-file Handbook for Authorized e-file Providers. I will keep form FTB 8453-EO on file for four years from the due date of the return or four years from the

date the exempt organization return is filed, whichever is later, and I will make a copy available to the FTB upon request. If I am also the paid preparer, under

penalties of perjury, I declare that I have examined the above exempt organization’s return and accompanying schedules and statements, and to the best

of my knowledge and belief, they are true, correct, and complete. I make this declaration based on all information of which I have knowledge.

Date

Check if

Check

ERO’s PTIN



ERO

ERO’s-

also paid

if self-

signature

preparer

employed

Must

FEIN



Sign

Firm’s name (or yours

if self-employed)

ZIP Code

and address

Under penalties of perjury, I declare that I have examined the above organization’s return and accompanying schedules and statements, and to the best of

my knowledge and belief, they are true, correct, and complete. I make this declaration based on all information of which I have knowledge.

Paid

Date

Check

Paid preparer’s PTIN



preparer’s

if self-

Preparer

signature

employed

Must