Form 8879 - Irs E-file Signature Authorization - 2016

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8879
OMB No. 1545-0074
IRS e-file Signature Authorization
Form
2016
Don’t send to the IRS. This isn’t a tax return.
Keep this form for your records.
Department of the Treasury
Internal Revenue Service
Information about Form 8879 and its instructions is at
Submission Identification Number (SID)
Taxpayer’s name
Social security number
Spouse’s name
Spouse’s social security number
Part I
Tax Return Information — Tax Year Ending December 31, 2016 (Whole dollars only)
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Adjusted gross income (Form 1040, line 38; Form 1040A, line 22; Form 1040EZ, line 4; Form 1040NR,
line 37) .
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Total tax (Form 1040, line 63; Form 1040A, line 39; Form 1040EZ, line 12; Form 1040NR, line 61) .
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Federal income tax withheld from Forms W-2 and 1099 (Form 1040, line 64; Form 1040A, line 40;
Form 1040EZ, line 7; Form 1040NR, line 62a) .
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Refund (Form 1040, line 76a; Form 1040A, line 48a; Form 1040EZ, line 13a; Form 1040-SS, Part I, line 13a;
Form 1040NR, line 73a) .
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Amount you owe (Form 1040, line 78; Form 1040A, line 50; Form 1040EZ, line 14; Form 1040NR, line 75)
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Part II
Taxpayer Declaration and Signature Authorization (Be sure you get and keep a copy of your return)
Under penalties of perjury, I declare that I have examined a copy of my electronic individual income tax return and accompanying schedules and statements
for the tax year ending December 31, 2016, and to the best of my knowledge and belief, it is true, correct, and accurately lists all amounts and sources of income
I received during the tax year. I further declare that the amounts in Part I above are the amounts from my electronic income tax return. I consent to allow my
intermediate service provider, transmitter, or electronic return originator (ERO) to send my return to the IRS and to receive from the IRS (a) an acknowledgement
of receipt or reason for rejection of the transmission, (b) the reason for any delay in processing the return or refund, and (c) the date of any refund. If applicable, I
authorize the U.S. Treasury and its designated Financial Agent to initiate an ACH electronic funds withdrawal (direct debit) entry to the financial institution
account indicated in the tax preparation software for payment of my federal taxes owed on this return and/or a payment of estimated tax, and the financial
institution to debit the entry to this account. This authorization is to remain in full force and effect until I notify the U.S. Treasury Financial Agent to terminate the
authorization. To revoke (cancel) a payment, I must contact the U.S. Treasury Financial Agent at 1-888-353-4537. Payment cancellation requests must be
received no later than 2 business days prior to the payment (settlement) date. I also authorize the financial institutions involved in the processing of the electronic
payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to the payment. I further acknowledge that the
personal identification number (PIN) below is my signature for my electronic income tax return and, if applicable, my Electronic Funds Withdrawal Consent.
Taxpayer’s PIN: check one box only
I authorize
to enter or generate my PIN
ERO firm name
Enter five digits, but
don’t enter all zeros
as my signature on my tax year 2016 electronically filed income tax return.
I will enter my PIN as my signature on my tax year 2016 electronically filed income tax return. Check this box only if you are
entering your own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III below.
Your signature
Date
Spouse’s PIN: check one box only
I authorize
to enter or generate my PIN
ERO firm name
Enter five digits, but
don’t enter all zeros
as my signature on my tax year 2016 electronically filed income tax return.
I will enter my PIN as my signature on my tax year 2016 electronically filed income tax return. Check this box only if you are
entering your own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III below.
Spouse’s signature
Date
Practitioner PIN Method Returns Only—continue below
Part III
Certification and Authentication — Practitioner PIN Method Only
ERO’s EFIN/PIN. Enter your six-digit EFIN followed by your five-digit self-selected PIN.
Don’t enter all zeros
I certify that the above numeric entry is my PIN, which is my signature for the tax year 2016 electronically filed income tax return for
the taxpayer(s) indicated above. I confirm that I am submitting this return in accordance with the requirements of the Practitioner PIN
method and Pub. 1345, Handbook for Authorized IRS e-file Providers of Individual Income Tax Returns.
ERO’s signature
Date
ERO Must Retain This Form — See Instructions
Don’t Submit This Form to the IRS Unless Requested To Do So
8879
For Paperwork Reduction Act Notice, see your tax return instructions.
Form
(2016)
Cat. No. 32778X
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