Form Ga-8453 S - Georgia S Corporate Income Tax Declaration For Electronic Filing Summary Of Agreement Between Taxpayer And Ero Or Paid Preparer - 2012
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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-8453 S
201 2
GEORGIA S CORPORATE INCOME TAX DECLARATION FOR ELECTRONIC FILING
SUMMARY OF AGREEMENT BETWEEN TAXPAYER AND ERO OR PAID PREPARER
Initial Net Worth
UET Annualiztion Exception attached
2012
2013
Extension
C Corp Last Year
Income Tax Return
Net Worth Return
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Beginning ____________________
Beginning ____________________
Original Return
Address Change
Ending
_____________________
Ending
_____________________
Amended Return
Final
Federal Employer I.D. Number
Name (Corporate
l t i t
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into GA
Location of Books (City & State)
Business Address
Incorporated under laws of
what state
Telephone Number
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ART
1. Federal ordinary income
(Form 600S, Line J) ..............................................................................................
1.
2. Total Income for Georgia purposes
(Form 600S, Sch 8, Line 11) ................................................................
2.
3. Net Worth
3.
(Form 600S, Sch 3, Line 4) ...........................................................................................................
4. Net Worth Taxable by Georgia
(Form 600S, Sch 3, Line 6) .........................................................................
4.
5. Tax Amounts
Income
..... Net Worth
(Form 600S, Sch 4, Line 1) ...........
6. Balance of Tax due with return
6.
(Form 600S, Sch 4, Line 10).......................................................................
Credited to 2013
...... Refunded
(Form 600S, Sch 4, Line 11) ...
7. Refund
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Under penaltiesof perjury, I declare that the information I have provided to the corporation’s ElectronicReturn Originator (ERO) and/or Online Service Provider and/or transmitter
and the amounts shown in Part I agree with the amounts shown on the correspondinglines of the electronicportion of the corporation’s 2012 Georgia CorporateIncomeTax Return.
I declarethat I have examinedthe corporation’s tax return,includingaccompanyingschedules and statements, and to the best of my knowledge and belief, the corporation’s return is
true, correct and complete. I consent that the electronic portion of the corporation’s return may be sent by my ERO/Online Service Provider/transmitter.
S
IGN
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DECLARATION OF ELECTRONIC RETURNS ORIGINATOR AND PAID PREPARER
ART
I DECLARE THAT I HAVE REVIEWED THEABOVE CORPORATION’S RETURNAND THATTHE ENTRIES ON THE GA-8453 SARE COMPLETE
AND CORRECTTO THE BEST OF MYKNOWLEDGE.
ERO’s Signature _________________________________________________________________
Date _______________________
ERO’s
Firm’s Name
__________________________________________________________________
Check if also paid preparer
Use
Address
__________________________________________________________________
Only
__________________________________________________________________
IF PREPARED BYA PERSON OTHER THAN THE TAXPAYER, THIS DECLARATION IS BASED ON ALL THE INFORMATION OF WHICH
THE TAXPAYER HAS KNOWLEDGE.
Paid Preparer’s Signature _________________________________________________________
Date _______________________
Paid
Firm’s Name
__________________________________________________________________
FEIN/PTIN _________________
Preparer’s
Address
__________________________________________________________________
SSN/TIN ___________________
Use Only
__________________________________________________________________
KEEP A COPY WITH YOUR RECORDS
GA-8453 S (REV 5/12)
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