Form Ia 8453-S - Iowa S Corporation Declaration For An E-File Return - 2012

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Iowa Department of Revenue
2012 IA 8453-S
Iowa S Corporation Declaration for an E-File Return
±
See Instructions
For calendar year 2012 or tax year beginning
, 2012, ending
, 20
Name of Corporation
Federal Employer Identification Number (FEIN)
Part I
Tax Return Information
1. Net Income (loss) from federal Schedule K (IA 1120S, Part III, line 1) ......... 1. ____________________
2. Total additions (IA 1120S, Part III, line 4) ........................................................... 2. ____________________
3. Total reductions (IA 1120S, Part III, line 8) ........................................................ 3. ____________________
4. Modified federal net income (IA 1120S, Part III, line 10) ................................. 4. ____________________
Part II
Declaration of Officer (Be sure to keep a copy of the tax return)
Under penalties of perjury, I declare that I am the president or other duly authorized officer of the above S corporation
and that the information I have provided to my Electronic Return Originator (ERO) and the amounts shown in Part I agree
with the amounts shown on the corresponding lines of the Iowa income tax return. To the best of my knowledge and
belief the S corporation return is true, correct, and complete. I consent that the S corporation’s return, including any
accompanying schedules and statements, be sent to the Internal Revenue Service (IRS) by my ERO and retrieved by the
Iowa Department of Revenue (IDR). If the S corporation is filing a balance due return, I understand that if the IDR does
not receive full and timely payment of its tax liability, the S corporation will remain liable for the tax liability and all
applicable penalties and interest. If there is an error on my federal return, I understand my state return may be rejected. If
the processing of my return is delayed, I authorize the IDR to disclose to my ERO and/or transmitter the reason(s) for the
delay. I also consent to the IDR sending to my ERO and/or transmitter an acknowledgment of receipt of transmission and
indication of whether or not my return is accepted, and, if rejected the reason(s) for the rejection. I understand that this
declaration with required attachments must be forwarded upon request to the IDR.
±
Sign
Here
Signature of Officer
Date
Title
Part III
Declaration of Electronic Return Originator (ERO) and Paid Preparer
I declare that I have reviewed the above return and that entries on form IA 8453-S 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 president or duly authorized officer will have signed this return
before submitting to the IRS. I have provided the officer with a copy of all forms and information to be filed with the
IDR and have followed all other requirements described in the Iowa Modernized e-File (MeF) Developer Guide and
Information for e-File Providers. I will keep form IA 8453-S, with attachments, on file for three years from the due date
of the return or the filing date, whichever is later, and I will make a copy available to the IDR upon request. If I am the
paid preparer, under penalties of perjury, I declare that I have examined the above S corporation return and
accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and
complete. This declaration is based on all information of which I have any knowledge.
ERO
±
Date
Check if also
Check if
ERO’s PTIN
ERO
Use
paid preparer
self-employed
Signature
Only
FEIN
Firm’s name (or yours
if self-employed),
address and ZIP code
Phone Number
(
)
Preparer’s PTIN
Date
Check if
Paid Preparer’s
±
Paid
self-employed
Signature
Preparer
Use
FEIN
Firm’s name (or yours
Only
if self-employed),
address and ZIP code
Phone Number
DO NOT MAIL
(
)
Retain completed form with your tax records for at least three years.
THIS FORM
42-013a (09/24/12)

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