Form In-Opt - Indiana Electronic Filing Opt-Out Declaration - 2012
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1Form
Indiana Electronic Filing Opt-Out Declaration
2012
IN-OPT
State Form 53952
Do not mail this form with the tax return
(R4 / 9-12)
Retain for your records
Your Name
Social Security Number
Spouse’s Name (if married and fi ling jointly)
Social Security Number
Paid Preparer’s Firm Name (or yours if self employed)
Paid Preparer’s PTIN
Under penalties of perjury, I, and my spouse if married fi ling jointly, declare that I/we do not want my/our professional
preparer to electronically fi le my/our 2012 Indiana individual income tax return.
Your Signature ______________________________________
Date _________________
Spouse’s Signature __________________________________
Date _________________
Electronic Filing Mandate
If a professional preparer fi les more than 10 individual income tax returns in a calendar year, for the subsequent year the
professional preparer must fi le returns for individuals in an electronic format, as specifi ed by the Department.
For returns fi led after Dec. 31, 2012, a penalty of $50 may be imposed on the professional preparer for each return that is
not fi led electronically (see Exception below). The maximum penalty is $25,000 per preparer per calendar year.
Exception: An individual may elect to opt-out of having his/her return electronically fi led. Form IN-OPT must be completed,
signed and retained on fi le by the paid preparer. A return fi led under these circumstances will not be subject to a penalty
for not being fi led electronically.
Notifi cation to professional preparer
• This form must be completed if your client(s) refuses to allow you to fi le his/her 2012 Indiana individual income tax
return electronically.
• You must keep this completed form on fi le with your records for fi ve years.
• Do not mail this form to the Indiana Department of Revenue.
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