Form Pa-8453-F - Pennsylvania Fiduciary Income Tax Declaration For Electronic Filing - 2015

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Declaration Control Number/Submission ID

PA DEPARTMENT OF REVENUE USE ONLY –

START

DO NOT WRITE OR STAPLE IN THIS SPACE

Form

PA-8453-F

PENNSYLVANIA FIDUCIARY INCOME TAX

2015

DECLARATION FOR ELECTRONIC FILING

For the year Jan. 1 – Dec. 31, 2015

Name of Estate or Trust

Employer Identification Number

Name and Title of Fiduciary

Type

Address (Number and Street including Rural Route or P.O. Box)

City, Town or Post Office

State

ZIP Code

The above information must match that on the electronic return exactly.

Tax Return Information (Enter whole dollars only.)

Part I

1. Net PA taxable income (Form PA-41, Line 9) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.

2. PA tax liability (Form PA-41, Line 12) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.

3. Total Payments and Credits (Form PA-41, Line 18) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.

4. Overpayment (Form PA-41, Line 23) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.

5. Total payment (tax due) (Form PA-41, Line 22) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.

Direct Deposit of Refund or Electronic Funds Withdrawal of Tax Due (Optional – See instructions.)

Part II

The first two numbers of the RTN must

6. Routing transit number (RTN)

be 01 through 12 or 21 through 32.

7. Depositor account number (DAN)

8. Type of account:

Checking

Savings

Debit date

MMDDYYYY

Declaration of Taxpayers (Sign only after Part I is complete.)

Part III

10.

I consent for the refund from the 2015 PA Fiduciary Income Tax Return to be directly deposited as designated in Part II and declare all information

shown on Lines 6 through 8 is correct. I certify the ultimate destination of the funds is within the U.S or one of its territories.

The estate or trust is not receiving a refund or I do not want direct deposit of the refund.

I authorize the PA Department of Revenue and its designated financial agent to initiate an ACH electronic funds withdrawal (direct debit) entry to the

financial institution account indicated for payment of the estate’s or trust’s taxes owed on this return, and I authorize the financial institution to debit the

entry to this account. I also authorize the financial institutions involved in the processing of the electronic payment of taxes to receive confidential

information necessary to answer inquires and resolve issues related to the payment. To revoke a payment, I may revoke this authorization by

notifying the PA Department of Revenue no later than two business days prior to the payment (settlement) date. I understand notification must be

made in writing by e-mail to ra-achrevok@pa.gov or by fax to 717-772-9310.

Under penalties of perjury, I declare that the amounts above match the amounts shown on the corresponding lines of the electronic portion of the 2015 PA Fiduciary Income

Tax Return. I have also examined a copy of the return being filed electronically with the PA Department of Revenue and all accompanying schedules and statements. To the

best of my knowledge and belief, they are true, correct and complete. If I am not the transmitter, I consent that the return and accompanying schedules and statements be

sent to the PA Department of Revenue by the transmitter. I also consent to the PA Department of Revenue sending the ERO and/or transmitter an acknowledgement of receipt

of transmission and an indication of whether or not the return is accepted, and if rejected, the reason(s) for the rejection.

MMDDYYYY

➧

Sign

Signature of Officer – Please sign after printing

Here

Signature of Fiduciary or Officer

Date

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

Part

I declare that I have reviewed the above-referenced estate or trust return and that the entries on PA-8435-F 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 fiduciary or an officer representing the

fiduciary will have signed this form before I submit the return. I will give the fiduciary or officer representing the fiduciary a copy of all forms and information to be filed with the

PA Department of Revenue, and I have followed all other requirements described in REV-993, Pennsylvania Fed/State E-file Handbook. If I am also the paid preparer, under

penalties of perjury, I declare that I have examined the above-referenced estate or trust return and accompanying schedules and statements, and to the best of my knowledge

and belief, they are true, correct and complete. Declaration of preparer is based on all information of which the preparer has any knowledge.

ERO’s

Check if also

Check if

ERO’s signature

Date

EIN/SSN or PTIN

➧

paid preparer

self-employed

Use

MMDDYYYY