Form 8453-Ol - California Online E-File Return Authorization For Individuals - 2012

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DO NOT MAIL THIS FORM TO THE FTB
Date Accepted___________________________
California Online e-file Return Authorization
TAXABLE YEAR
FORM
2012
for Individuals
8453-OL
Your first name and initial
Last name
Your SSN or ITIN
If joint return, spouse’s/RDP’s first name and initial
Last name
Spouse’s/RDP’s SSN or ITIN
Address (including number and street, PO Box, or PMB no.)
Apt. no./Ste.no.
Daytime telephone number
City
State
ZIP code
Part I Tax Return Information (whole dollars only)
1 California adjusted gross income. (Form 540, line 17; Form 540 2EZ, line 16; Long Form 540NR, line 32;
or Short Form 540NR, line 32). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
2 Refund or no amount due. (Form 540, line 115; Form 540 2EZ, line 28; Long Form 540NR, line 125;
or Short Form 540NR, line 125). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
3 Amount you owe. (Form 540, line 111; Form 540 2EZ, line 27; Long Form 540NR, line 121;
or Short Form 540NR, line 121). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Part II Settle Your Account Electronically for Taxable Year 2012 (Due 04/15/2013)
4 m Direct deposit of refund
5 m Electronic funds withdrawal 5a Amount ___________________ 5b Withdrawal date (MM/DD/YYYY) _________________
Part III Make Estimated Tax Payments for Taxable Year 2013 These are not installment payments for the current amount you owe.
First Payment
Second Payment
Third Payment
Fourth Payment
Due 4/15/13
Due 6/17/13
Due 9/16/13
Due 1/15/14
6 Amount
7 Withdrawal date
Part IV Banking Information (Have you verified your banking information?)
8 Amount of refund to be directly deposited to account below _____________ 12 The remaining amount of my refund for direct deposit _________________
9 Routing number _______________________________________________ 13 Routing number _______________________________________________
10 Account number _______________________________________________ 14 Account number ______________________________________________
11 Type of account: m Checking
m Savings
15 Type of account: m Checking
m Savings
Part V Declaration of Taxpayer(s)
I authorize my account to be settled as designated in Part II. If I check Part II, box 4, I declare that the direct deposit refund information in
Part IV agrees with the authorization stated on my return. I authorize an electronic funds withdrawal for the amount listed on line 5a and any
estimated payment amounts listed on line 6 from the account listed on lines 9, 10, and 11. If I have filed a joint return, this is an irrevocable
appointment of the other spouse/RDP as an agent to receive the refund or authorize an electronic funds withdrawal.
Under penalties of perjury, I declare that the information I provided to the Franchise Tax Board (FTB), either directly or through e-file
software, including my name, address, and social security number (SSN) or individual taxpayer identification number (ITIN), and the
amounts shown in Part I above, agrees with the information and amounts shown on the corresponding lines of my 2012 California income
tax return. To the best of my knowledge and belief, my return is true, correct, and complete. If I am filing a balance due return, I understand
that if the FTB does not receive full and timely payment of my tax liability, I remain liable for the tax liability and all applicable interest and
penalties. I authorize my return and accompanying schedules and statements to be transmitted to the FTB directly or through the e-file
software. If the processing of my return or refund is delayed, I authorize the FTB to disclose to me, either directly or through the e-file
software, the reason(s) for the delay or the date when the refund was sent.
Sign
Here
Your signature
Date
Spouse’s/RDP’s signature. If filing jointly, both must sign.
Date
It is unlawful to forge a spouse’s/RDP’s signature.
FTB 8453-OL
2012
C2
For Privacy Notice, get form FTB 1131.

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