Form Tc-8453 - Utah Individual Income Tax Transmittal For Electronic Filing - 2004
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1IRS-DCN
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Clear form
2004
Utah State Tax Commission
Utah Individual Income Tax
TC-8453
Transmittal For Electronic Filing
Rev. 12/04
For the year January 1 - December 31, 2004
Your Social Security number
Your full name (first, middle initial, last)
Spouse's Social Security number
Spouse's name (first, middle initial, last)
Daytime telephone number
Mailing address
(
)
IMPORTANT!
State
ZIP code + 4
City
Evening telephone number
(
)
Social Security Number(s) Required
Foreign city
Foreign state & zip
Foreign country
Declaration of Taxpayer for State Only Returns
Under penalties of perjury, I declare I have compared my 2004 Utah Individual Income Tax return with the information I provided to my
Electronic Return Originator, and to the best of my knowledge and belief, my return is true, correct and complete. This declaration is to be
forwarded to the Utah State Tax Commission by my Electronic Return Originator as validation of my electronically filed Utah Individual
Income Tax return. I understand if there is an error in my return, it will be rejected and any Utah refund to which I may be entitled may be
delayed.
Date
Date
Taxpayer signature
Spouse signature
This form is to be filed ONLY if the taxpayer(s) is filing a
Declaration of Taxpayer for State Only Returns.
A taxpayer may
"Utah State Only Return" electronically separate from their
file their Utah State return electronically, separate from their federal
return. If a "Utah State Only Return" is being filed, the signature of the
federal return.
taxpayer and/or spouse is required.
IRS-DCN.
Enter the same 14-digit Document Control Number
DO NOT include a copy of your return or withholding forms (W-2, W-
(DCN) assigned by the Electronic Return Originator (ERO) to
2G, 1099G, and 1099R).
identify your electronically submitted federal tax return.
When and Where to File
Name, Address, Social Security Number.
Your social security
The ERO must mail the TC-8453 to the
Utah State Tax Commission,
number(s) and name(s) must match your social security card(s).
Type or print your social security number(s), name(s), address
210 N 1950 W, Salt Lake City, UT 84134-0210
, no later than the next
and telephone number(s) in the spaces provided. If you file a joint
working day after receiving the state acknowledgment that the return
was received and accepted. If a third-party transmitter is used, the
return, make sure that you enter the social security numbers in
ERO must mail this information the next working day after receiving
the same order your names are shown.
Also, type or print your
the state acknowledgment from the Transmitter.
daytime and evening telephone numbers.
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