Form Ga-8453f - Georgia Fiduciary Income Tax Declaration For Electronic Filing Summary Of Agreement Between Taxpayer And Ero Or Paid Preparer - 2015
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1
2PRINT
CLEAR
ERO MUST RETAIN THIS FORM
DO NOT SUBMIT THIS FORM TO
GEORGIA DEPARTMENT OF REVENUE
UNLESS REQUESTED TO DO SO.
GA-8453F
IRS DCN OR SUBMISSION ID
201 5
GEORGIA FIDUCIARY INCOME TAX DECLARATION FOR ELECTRONIC FILING
SUMMARY OF AGREEMENT BETWEEN TAXPAYER AND ERO OR PAID PREPARER
Name of Estate or Trust
Date of Creation of Trust
A. Federal Employer Id. No.
Date of Decedent’s Death
Name of Fiduciary
Title of Fiduciary
T
elephone No.
B.
( Apt., Suite or Building Number)
C.
Address of Fiduciary (Number and Street)
City
State
Zip Code
Country
D.
If no return was filed last year, state reason
P
I
TAX RETURN INFORMATION
ART
1. Income of Fiduciary (Form 501, Line 1) ................................................................................................ 1.
2. Total (Form 501, Net Total of Line 1 & 2) ............................................................................................. 2.
3. Total Tax (Form 501, Line 8) ................................................................................................................. 3.
4. Balance Due (Form 501, Line 19) .......................................................................................................... 4.
5. Refund (Form 501, Line 20) ................................................................................................................... 5.
P
II
DECLARATION OF TAXPAYER(S)
ART
Under penalties of perjury, I declare that the information I have provided to my Electronic Return Originator (ERO) and/or Online Service
Provider and/or Transmitter and the amounts shown in Part I agree with the amounts shown on the corresponding lines of the electronic
portion of my 2015 Georgia Fiduciary Tax Return. I declare that I have examined my tax return, including accompanying schedules and
statements, and to the best of my knowledge and belief, my return is true, correct and complete. I consent that the electronic portion of my
return may be sent by my ERO/Online Service Provider/Transmitter.
S
IGN
H
TAXPAYER’S SIGNATURE
Date
SPOUSE’S SIGNATURE (if joint return, both must sign)
Date
ERE
EMAIL ADDRESS
PRINT NAME
P
III
DECLARATION OF ELECTRONIC RETURNS ORIGINATOR AND PAID PREPARER
ART
I DECLARE THAT I HAVE REVIEWED THE ABOVE TAXPAYER’S RETURN AND THAT THE ENTRIES ON THE GA-8453F ARE COMPLETE
AND CORRECT TO THE BEST OF MY KNOWLEDGE.
ERO’s Signature _____________________________________________________________
Date ______________________
ERO’s
Firm’s Name
_______________________________________________________________
Check if also paid preparer
Use
Address
_______________________________________________________________
FEIN/PTIN
Only
_______________________________________________________________
SSN/TIN
IF PREPARED BYANY PERSON OTHER THAN THE TAXPAYER, THIS DECLARATION IS BASED ON ALL INFORMATION OF WHICH
THE TAXPAYER HAS ANY KNOWLEDGE.
Paid Preparer’s Signature _____________________________________________________
Date ______________________
Paid
Firm’s Name
_______________________________________________________________
FID/TIN
Preparer’s
Addre
ss
_______________________________________________________________
SSN/TIN
Use Only
_______________________________________________________________
(Rev. 9/15)
KEEP A COPY WITH YOUR RECORDS
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