Form Il-8453 - Illinois Individual Income Tax Electronic Filing Declaration - 2002
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Illinois Department of Revenue
Declaration Control Number (DCN)
IL-8453
2002 Illinois Individual Income Tax Electronic Filing Declaration
Step 1: Provide taxpayer information
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_________________________________________________________________________________________
____ ____ ____
____ ____
____ ____ ____ ____
First name and middle initial
Spouse’s first name (and last name if different)
Last name
Social Security number
Print
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_________________________________________________________________________________________
____ ____ ____
____ ____
____ ____ ____ ____
or
Mailing address
Spouse’s Social Security number
type
(
)
_________________________________________________________________________________________
City
State
ZIP
Daytime phone number
Step 2: Complete information from tax return
1
1
Net income from Form IL-1040, Line 13, or Schedule NR, Step 5, Line 52
2
2
Tax from Form IL-1040, Line 16
3
3
Illinois Income Tax withheld from Form IL-1040, Line 17 only (write “0” if none)
4
4
Overpayment from Form IL-1040, Line 30
5
5
Total amount due from Form IL-1040, Line 34
6
Filing status: ___ Single/head of household ___ Married filing jointly ___ Married filing separately ___ Widowed
Step 3: Complete direct deposit of refund or electronic funds withdrawal information
(Optional)
7
Routing no. (RN): ___ ___ ___ ___ ___ ___ ___ ___ ___
8
Account no. (AN): ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
9
Type of account:
___ Checking
___ Savings
10
Date the payment is to be electronically withdrawn: ___/___/______
11
Electronic funds withdrawal amount:
12
Name on account: ____________________________________________________________________________________________
Step 4: Taxpayer declaration and signature
(Sign only after Step 2 and Step 3 (if applicable) is completed.)
I consent that my refund may be directly deposited as designated in Step 3 and declare the information 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.
I authorize the Illinois Department of Revenue (IDOR) and its designated financial agent to initiate an ACH electronic funds
withdrawal as designated in the electronic portion of my 2002 Illinois income tax return. I authorize the financial institutions
involved in the processing of an electronic overpayment of taxes to receive confidential information necessary to answer inquiries
and resolve issues related to the payment.
I do not want direct deposit of my refund, or an electronic funds withdrawal (direct debit) of my balance due.
Under penalties of perjury, I declare the information on my electronic IL-1040 return and the information I provided to my electronic return origina-
tor (ERO) are identical. To the best of my knowledge, my return is true, correct, and complete. I consent that my return, this declaration, and
accompanying information may be sent to IDOR by my ERO. I authorize IDOR to inform my ERO and/or the transmitter when my return has been
accepted or rejected. If rejected, I authorize IDOR to identify the reason(s) so the return may be corrected and retransmitted if possible.
Sign
_____________________________________________________________________
__________________________________________________________________
here
Your signature
Date
Spouse’s signature (if joint return, both must sign)
Date
Step 5: Electronic return originator (ERO) and paid preparer declaration and signature
I declare that I have examined this taxpayer’s electronic IL-1040 return, the information on this Form IL-8453, and accompanying informa-
tion. I have followed all requirements of this program and declare, under penalties of perjury, that to the best of my knowledge the
taxpayer’s return and accompanying information are true, correct, and complete.
Check if paid preparer:
(See instructions.)
ERO’s signature
Date
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____ ____ ____
____ ____
____ ____ ____ ____
ERO
Firm’s name or your name if self-employed
Your Social Security number (SSN) or PTIN
use
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____ ____
____ ____ ____ ____ ____ ____ ____
only
Mailing address
Federal employer identification number (FEIN)
(
)
City
State
ZIP
Phone number
Step 6: Attach all required documents
( e.g., copy 2 of Forms W-2, W-2G, 1099-R, out-of-state returns, etc. )
IL-8453 (R-10/02)
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