Form Ia 8453-Pe - Iowa Partnership Declaration For An E-File Return

Iowa Department of Revenue

2012 IA 8453-PE

Iowa Partnership Declaration for an E-File Return

See Instructions

For calendar year 2012, or tax year beginning

, 2012, and ending

Name of Partnership

FEIN

Part I

Return Information

1. Federal partnership taxable income (loss) from federal Schedule K (IA 1065, Part III, line 1) . 1. _________________

2. Total additions (IA 1065, Part III, line 4) .............................................................................................. 2. _________________

3. Total reductions (IA 1065, Part III, line 7) ........................................................................................... 3. _________________

4. Total all-source partnership income (IA 1065, Part III, line 9) ......................................................... 4. _________________

Part II

Declaration of General Partner or Limited Liability Company Member Manager

Be sure to keep a copy of the partnership’s tax return.

Under penalties of perjury, I declare that I am a partner or member of the above partnership and that the information

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 partnership return of income. To the best of my knowledge and belief the partnership’s

return is true, correct, and complete. I consent that the Iowa partnership 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 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 Partner or Member

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-PE 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. A partner or member will have signed this return before submitting to the IRS. I

have provided the partner or member 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-PE, 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 partnership 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

paid preparer

Signature

self-employed

Use

Only

FEIN

Firm’s name (or yours

if self-employed),

address and ZIP code

Phone Number

(

)

Check if

Paid Preparer’s

Date

Preparer’s PTIN

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

(

)

THIS FORM

Keep completed form with your tax records for at least three years.

41-022a (09/25/12)

Form Ia 8453-Pe - Iowa Partnership Declaration For An E-File Return - 2012

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