Form 8453 - California E-File Return Authorization For Individuals - 2012

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DO NOT MAIL THIS FORM TO THE FTB
_______________________
Date Accepted
TAXABLE YEAR
FORM
2012
8453
California e-file Return Authorization for Individuals
Your first name and initial
Last name
Your SSN or ITIN
If joint return, spouse’s/RDP’s first name and initial
Last name
Spouse’s/RDP’s SSN or ITIN
Address (include number and street, PO Box, or PMB no.)
Apt. no. /Ste. no.
Daytime telephone number
City
State
ZIP Code
Part I Tax Return Information (whole dollars only)
1 California adjusted gross income. (Form 540, line 17; Form 540 2EZ, line 16; Long Form 540NR, line 32; or Short Form 540NR, line 32) 1
2 Refund or no amount due. (Form 540, line 115; Form 540 2EZ, line 28; Long Form 540NR, line 125; or Short Form 540NR, line 125) . 2
3 Amount you owe. (Form 540, line 111; Form 540 2EZ, line 27; Long Form 540NR, line 121; or Short Form 540NR, line 121) . . . . . . 3
Part II Settle Your Account Electronically for Taxable Year 2012 (Due 04/15/13)
m
m
4
 Direct deposit of refund 5
 Electronic funds withdrawal 5a Amount ___________________ 5b Withdrawal date
___________
(MM/DD/YYYY)
Part III Make Estimated Tax Payments for Taxable Year 2013 These are NOT installment payments for the current amount you owe.
First Payment Due 4/15/13
Second Payment Due 6/17/13
Third Payment Due 9/16/13
Fourth Payment Due 1/15/14
6 Amount
7 Withdrawal date
Part IV
Banking Information
(Have you verified your banking information?)
8 Amount of refund to be directly deposited to account below ________________ 12 The remaining amount of my refund for direct deposit ___________________
9 Routing number _______________________________________________ 13 Routing number _____________________________________________
10 Account number _______________________________________________ 14 Account number _____________________________________________
11 Type of account: m Checking
m Savings
15 Type of account: m Checking
m Savings
Part V Declaration of Taxpayer(s)
I authorize my account be settled as designated in Part II. If I check Part II, Box 4, I declare that the direct deposit refund information in Part IV agrees with the authorization
stated on my return. If I check Part II, Box 5, I authorize an electronic funds withdrawal for the amount listed on line 5a and any estimated payment amounts listed on line
6 from the account listed on lines 9, 10, and 11. If I have filed a joint return, this is an irrevocable appointment of the other spouse/RDP 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 my electronic return originator (ERO), transmitter, or intermediate service provider, including my
name, address, and social security number (SSN) or individual taxpayer identification number (ITIN), and the amounts shown in Part I above agrees with the information
and amounts shown on the corresponding lines of my 2012 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 Franchise Tax Board (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 be transmitted to the FTB by my ERO, transmitter, or
intermediate service provider. If the processing of my return or refund is delayed, I authorize the FTB to disclose to my ERO, intermediate service provider, the reason(s)
for the delay or the date when the refund was sent.
Sign
Here
Your signature
Date
Spouse’s/RDP’s signature. If filing jointly, both must sign. Date
It is unlawful to forge a spouse’s/RDP’s signature.
Part VI Declaration of Electronic Return Originator (ERO) and Paid Preparer. See instructions.
I declare that I have reviewed the above taxpayer’s return and that the entries on form FTB 8453 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 taxpayer’s return. I declare, however, that form FTB 8453 accurately reflects the data on the return.) I have
obtained the taxpayer’s signature on form FTB 8453 before transmitting this return to the FTB; I have provided the taxpayer 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. 1345, 2012 e-file Handbook for Authorized e-file Providers. I will keep form FTB 8453 on file for four
years from the due date of the return or four years from the date the 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 taxpayer’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’s-
also paid
if self-
ERO
signature
preparer
employed
Must
FEIN
Firm’s name (or yours
Sign
if self-employed)
ZIP Code
and address
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. I make this declaration based on all information of which I have knowledge.
Paid
Paid
Date
Check
Paid preparer’s PTIN
preparer’s
if self-
Preparer
signature
employed
Must
FEIN
Firm’s name (or yours
Sign
if self-employed)
ZIP Code
and address
FTB 8453 C2 2012
For Privacy Notice, get form FTB 1131.

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