Form Al8453-B - Business Privilege Tax Declaration For Electronic Filing - Alabama Department Of Revenue - 2013

FORM

A

D

R

LABAMA

EPARTMENT OF

EVENUE

AL8453-B

2013

I

& C

T

D

NDIVIDUAL

ORPORATE

AX

IVISION

Business Privilege Tax

Declaration for Electronic Filing

For the tax period ______________________________, 20_______, through ______________________________, 20_______

NAME OF COMPANY

FEDERAL EMPLOYER IDENTIFICATION NUMBER

ADDRESS OF COMPANY

TELEPHONE NUMBER

BPT ACCOUNT NUMBER

PART I

Tax Return Information (Whole Dollars Only)

1

1 Net Annual Report Fee Due (Forms CPT and PPT, line 8) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2

2 Total Business Privilege Tax Due (Forms CPT and PPT, line 14) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3

3 Refund (Forms CPT and PPT, line 17) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4

4 Amount you owe (Forms CPT and PPT, line 15) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5

5 Amount of payment remitted electronically . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PART II

Declaration of Officer/Partner (Sign only after Part I is completed.)

Under penalties of perjury, I declare that I am an officer/partner of the above company and that the information I have given my electronic return originator (ERO), transmitter, and/or inter-

mediate service provider (ISP) and the amounts in Part I above agree with the amounts on the corresponding lines of the company’s Alabama income tax return. To the best of my knowl-

edge and belief, the company’s return is true, correct, and complete. I consent to my ERO, transmitter, and/or ISP sending the company’s return, this declaration, and accompanying sched-

ules and statements to the Alabama Department of Revenue. I also consent to the Alabama Department of Revenue sending my ERO, transmitter, and/or ISP an acknowledgment of receipt

of transmission and an indication of whether or not the company’s return is accepted, and, if rejected, the reason(s) for the rejection. I have selected a personal identification number (PIN)

as my signature for the corporation/partnership’s electronic income tax return and, if applicable, the corporation/partnership’s consent to electronic funds withdrawal.

I authorize the Alabama Department of Revenue and its designated Financial Agent to initiate an electronic funds withdrawal (direct debit) entry to the financial institution account

indicated in the tax preparation software for payment of the corporation/partnership’s Alabama taxes owed on this return, and the financial institution to debit the entry to this account.

I authorize a representative of the Department of Revenue to discuss my return and attachments with my preparer.

Sign

Here

Signature of Officer/Partner

Date

Title

PART III

Declaration of Electronic Return Originator (ERO) and Paid Preparer (See Instructions)

I declare that I have reviewed the above company’s return and that the entries on Form AL8453-B 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 the return. The company’s officer will have signed this form before I submit the return. I

will give the officer a copy of all forms and information to be filed with the Alabama Department of Revenue, and have followed all other requirements in Pub. 3112, IRS e-file Application

and Participation, and Pub. 4163, Modernized e-File Information for Authorized IRS e-file Providers and Pub. AL4164 Software Developers and Transmitters Guidelines and Schemas for

Alabama Business Privilege Tax Returns. If I am also the Paid Preparer, under penalties of perjury I declare that I have examined the above company’s return and accompanying sched-

ules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. This Paid Preparer declaration is based on all information of which I have any

knowledge.

Date

ERO’s PTIN

Check if also

Check if

ERO’s

ERO’s

paid preparer

self-employed

signature

Use

EIN

Firm’s name (or yours

Only

if self-employed),

address and ZIP code

Phone No. (

)

Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct,

and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Date

Preparer’s PTIN

Check if

Preparer’s

Paid

self-employed

signature

Preparer’s

EIN

Firm’s name (or yours

Use Only

if self-employed),

address and ZIP code

Phone No. (

)

ERO must retain this form for a period of three years from the due date of the return or the date the return was filed, whichever is later.

Do not submit this form to the Alabama Department of Revenue unless requested to do so.