Form 8453n - Nebraska Individual Income Tax Transmittal For E-Filed Returns - 2012
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FORM 8453N
Nebraska Individual Income Tax Transmittal for E-Filed Returns
2012
for Tax Year Beginning January 1 and Ending December 31, 2012
First Name and Initial
Last Name
PLEASE DO NOT WRITE IN THIS SPACE
If a Joint Return, Spouse’s First Name and Initial
Last Name
Current Mailing Address (Number and Street or PO Box)
City
State
Zip Code
Social Security Number
Spouse’s Social Security Number
Email Address
Mail Form 8453N and applicable documentation only when the e-filed Nebraska Individual Income
Tax Return requires this information to substantiate a claim or credit, and your software does not
support this form in e-file. Documentation must be received within 15 days of e-filing your return or
the claim or credit will be disallowed.
Check the applicable boxes to identify attachments.
S
Form 1099 BFC, Certificate for Beginning Farmer Credit
T
Form 1099-MISC, Form 1099-OID, Form 1099-INT (only if Nebraska withholding is shown)
A
T
Form 1310N, Nebraska Refund for Deceased Taxpayers
If filing as personal representative, attach proof of appointment.
E
All other persons, attach proof of death.
Form 2210N, Individual Underpayment of Estimated Tax, when the “annualizing income” box is checked;
O
or if claiming “waiver of penalty,” attach explanation.
F
Form 33, Power of Attorney
Form NFC, Statement of Nebraska Financial Institution Tax Credit
N
Form 4797N, Special Capital Gains/Extraordinary Dividend Election and Computation (see instructions)
E
B
Form RRB-1099 or RRB-1099R, Tax Statement from Railroad Retirement Board
R
A
S
K
A
, 800-742-7474 (NE and IA), 402-471-5729
8-523-2012
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