Form Ga-8453c - Georgia Corporate Income Tax Declaration For Electronic Filing - Summary Of Agreement Between Taxpayer And Ero Or Paid Prepayer - 2016

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CLEAR
ERO MUST RETAIN THIS FORM.
DO NOT SUBMIT THIS FORM TO
GEORGIA DEPARTMENT OF REVENUE
UNLESS REQUESTED TO DO SO.
IRS DCN OR SUBMISSION ID
GA-8453C
2016
GEORGIA CORPORATE INCOME TAX DECLARATION FOR ELECTRONIC FILING
SUMMARY OF AGREEMENT BETWEEN TAXPAYER AND ERO OR PAID PREPARER
GA Consolidated Subsidiary
Address Change
Consolidated Parent FEIN
Name Change
2017
_____________________
Final
2016
Income Tax Return
Net Worth Return
PL 86-272
Consolidated GA Parent
IT-552
Beginning ____________________
Beginning ____________________
Original Return
Initial Net Worth
Ending
_____________________
Ending
_____________________
Amended Return
Extension
Federal Employer ID Number
Name (Corporate title)
Date admitted into GA
Location of Books (City & State)
Business Address
Incorporated under laws of
what state
Telephone Number
City or Town
State
Zip Code
NAICS Code
P
I
TAX RETURN INFORMATION
ART
1. Federal taxable income
1.
(Form 600, Sch 1, Line 1) ......................................................................................
2. Georgia taxable income
2.
(Form 600, Sch 1, Line 7) .....................................................................................
3. Net Worth
3.
(Form 600, Sch 2, Line 4) ............................................................................................................
4. Net Worth Taxable by Georgia
4.
(Form 600, Sch 2, Line 6) ..........................................................................
5. Tax Amounts
Income
..... Net Worth
(Form 600, Sch 3, Line 1) ............
6. Balance of Tax due with return
(Form 600, Sch 3, Line 10)........................................................................
6.
7. Refund
Credited to 2017
...... Refunded
(Form 600, Sch 3, Line 11) ....
P
II
DECLARATION OF CORPORATE OFFICER
ART
Underpenaltiesofperjury, Ideclare that the informationIhaveprovidedto the corporation’sElectronicReturnOriginator(ERO)and/orOnline Service Providerand/orTransmitter
andthe amountsshownin Part Iagree withthe amountsshownonthe correspondinglinesofthe electronicportionofthe corporation’s2016 Georgia CorporateIncomeTaxReturn.
IdeclarethatIhave examinedthe corporation’staxreturn,includingaccompanyingschedulesandstatements,andtothebest ofmyknowledge andbelief,the corporation’sreturnis
true,correct and complete. Iconsent that the electronicportion ofthe corporation’sreturn may be sent bymyERO/Online ServiceProvider/Transmitter.
S
IGN
H
SIGNATURE OF OFFICER
ERE
DATE
TITLE
PRINT NAME
EMAIL
P
III
DECLARATION OF ELECTRONIC RETURNS ORIGINATOR AND PAID PREPARER
ART
I DECLARE THAT I HAVE REVIEWED THEABOVE CORPORATION’S RETURNAND THAT THE ENTRIES ONTHE GA-8453C ARE COMPLETE
AND CORRECTTO THE BEST OF MYKNOWLEDGE.
ERO’s Signature _________________________________________________________________
Date _______________________
ERO’s
Firm’s Name
__________________________________________________________________
Check also if paid preparer
Use
Address
__________________________________________________________________
Only
City, State & Zip Code ________________________________________________________________
IF PREPARED BYA PERSON OTHER THAN THE TAXPAYER, THIS DECLARATION IS BASED ON ALL THE INFORMATION OF WHICH
THE TAXPAYER HAS ANY KNOWLEDGE.
Paid Preparer’s Signature _________________________________________________________
Date _______________________
Paid
Firm’s Name
__________________________________________________________________
FEIN/PTIN _________________
Preparer’s
Address
__________________________________________________________________
SSN/TIN ___________________
Use Only
City, State & Zip Code ________________________________________________________________
KEEP A COPY WITH YOUR RECORDS
GA-8453C (REV. 09/23/16)

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